| NPI | 1366802159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY M KIDIAVAYI Nurse Practictioner 702-400-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002072) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |