Provider Demographics
NPI:1073775367
Name:WILTZ, KEVIN (CNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WILTZ
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 WYNN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7823
Mailing Address - Country:US
Mailing Address - Phone:702-966-2414
Mailing Address - Fax:702-629-7647
Practice Address - Street 1:3280 WYNN RD
Practice Address - Street 2:STE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7823
Practice Address - Country:US
Practice Address - Phone:702-966-2414
Practice Address - Fax:702-629-7647
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA002785376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide