| NPI | 1992672612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DOCKERY Manager 702-406-9873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| 163WW0000X Registered Nurse, Wound Care | |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2025-10-17 |