1629200746 NPI number — NEVADA STATE HEALTH DIVISION/FAR NURSIN

Table of content: (NPI 1629200746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629200746 NPI number — NEVADA STATE HEALTH DIVISION/FAR NURSIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA STATE HEALTH DIVISION/FAR NURSIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1629200746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 TECHNOLOGY WAY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89706-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-684-5900
Provider Business Mailing Address Fax Number:
775-684-3492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E HASKELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-623-6575
Provider Business Practice Location Address Fax Number:
775-623-6576
Provider Enumeration Date:
08/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WHERRY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
DIRECTOR OF CLINICAL SERVICES, FAR/
Authorized Official Telephone Number:
775-684-4018

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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