Provider Demographics
NPI:1033243076
Name:R DOMINIC NARDELL MD PC
Entity Type:Organization
Organization Name:R DOMINIC NARDELL MD PC
Other - Org Name:NARDELL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:NARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-558-2111
Mailing Address - Street 1:1930 VILLAGE CENTER CIR STE 3-328
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6238
Mailing Address - Country:US
Mailing Address - Phone:702-558-2111
Mailing Address - Fax:702-558-8333
Practice Address - Street 1:3150 N TENAYA WAY STE 370
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0485
Practice Address - Country:US
Practice Address - Phone:702-558-2111
Practice Address - Fax:702-558-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103692Medicare PIN