Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 812452 | NV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 812452 | NV |
NPI | 1235607730 |
---|---|
Provider Name | Marcus Mccomas |
First Address | Henderson, NV 89002-3394 |
Second Address | North Las Vegas, NV 89086-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 09/11/2018 |