Provider Demographics
NPI:1255321774
Name:NATION, NINA V (PA-C)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:V
Last Name:NATION
Suffix:
Gender:F
Credentials:PA-C
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 36310
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6310
Mailing Address - Country:US
Mailing Address - Phone:702-382-1599
Mailing Address - Fax:702-240-4962
Practice Address - Street 1:2481 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0825
Practice Address - Country:US
Practice Address - Phone:702-382-1599
Practice Address - Fax:702-240-4962
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1255321774Medicaid
NV1255321774Medicaid
NV100501236Medicaid
NVQ02318Medicare UPIN