1366532434 NPI number — TIKVA DARVISH BUTLER RN, APN

Table of content: DANAJAH ANDERSON LPN (NPI 1962399352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366532434 NPI number — TIKVA DARVISH BUTLER RN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
TIKVA
Provider Middle Name:
DARVISH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366532434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8906 SPANISH RIDGE AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-1304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-330-3102
Provider Business Mailing Address Fax Number:
702-912-4994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2860 E. DESERT INN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-796-9997
Provider Business Practice Location Address Fax Number:
702-796-1440
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  00106 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366532434 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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