Provider Demographics
NPI:1275199820
Name:DODD, MACEY (APRN)
Entity Type:Individual
Prefix:
First Name:MACEY
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 PINK STARGAZER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3785
Mailing Address - Country:US
Mailing Address - Phone:702-808-6359
Mailing Address - Fax:
Practice Address - Street 1:10620 SOUTHERN HIGHLANDS PKWY STE 110-155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4371
Practice Address - Country:US
Practice Address - Phone:702-754-5421
Practice Address - Fax:775-312-2857
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF05190039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily