Provider Demographics
NPI:1093709933
Name:PEARL, JOANNE E (NP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:E
Last Name:PEARL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 W TWAIN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6723
Mailing Address - Country:US
Mailing Address - Phone:702-722-2200
Mailing Address - Fax:702-722-2201
Practice Address - Street 1:10155 W TWAIN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6722
Practice Address - Country:US
Practice Address - Phone:702-722-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE-22362Medicare UPIN