Provider Demographics
NPI:1073115614
Name:DIOLA, LEA (NP-C)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:DIOLA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5613
Mailing Address - Country:US
Mailing Address - Phone:702-476-4900
Mailing Address - Fax:
Practice Address - Street 1:4445 S EASTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7851
Practice Address - Country:US
Practice Address - Phone:702-410-5319
Practice Address - Fax:702-442-1494
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN191089163WM0705X
NVRN95778163WM0705X
NV842695363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical