Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 369 | NV |
NPI | 1013124601 |
---|---|
Provider Name | Richard P Null |
First Address | Las Vegas, NV 89146-1126 |
Second Address | Las Vegas, NV 89146-1126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 27/02/2008 |