| NPI | 1720807563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY M KIDAVAYI CEO 702-601-1360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2024-10-08 |