Provider Demographics
NPI:1114222551
Name:PFEIFFER, AMY MARTINE (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARTINE
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3131 LA CANADA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2578
Practice Address - Country:US
Practice Address - Phone:702-216-3346
Practice Address - Fax:702-671-6883
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV111789OtherSMA MEDICARE
NVPENDINGMedicaid
NVV111789OtherSMA MEDICARE