Provider Demographics
NPI:1093151227
Name:MECHAM, DUSTIN V (RN)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:V
Last Name:MECHAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 THOMAS PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8934
Mailing Address - Country:US
Mailing Address - Phone:702-630-9662
Mailing Address - Fax:
Practice Address - Street 1:930 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1001
Practice Address - Country:US
Practice Address - Phone:702-383-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7877248-3102163W00000X
NVRN72654163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse