1881726099 NPI number — WILLIAM NEAL EVANS, MD, LTD

Table of content: MOLLIE ALANNA DESIMONE CRNP (NPI 1356856215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881726099 NPI number — WILLIAM NEAL EVANS, MD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM NEAL EVANS, MD, LTD
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:
1881726099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 LA CANADA ST STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89169-2551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-732-1290
Provider Business Mailing Address Fax Number:
702-732-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6630 S MCCARRAN BLVD STE 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-6182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-321-6644
Provider Business Practice Location Address Fax Number:
775-322-4748
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
702-990-4821

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100500157 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: XGG007170 . This is a "MEDI-CAL" identifier . This identifiers is of the category "OTHER".