Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 841794 | NV |
NPI | 1003488214 |
---|---|
Provider Name | Shiva Adham |
First Address | Carson City, NV 89703-8363 |
Second Address | Reno, NV 89521-6009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2021 |
Last Update Date | 15/07/2021 |