| NPI | 1871291872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY SHANDREKA PETERSON Managing Member/ Nurse Practitioner 702-350-2032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2025-01-27 |