Provider Demographics
NPI:1356642490
Name:THREET, RANDI (APN)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:THREET
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 SAINT ROSE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4845
Mailing Address - Country:US
Mailing Address - Phone:702-248-7337
Mailing Address - Fax:702-478-5465
Practice Address - Street 1:2847 SAINT ROSE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4845
Practice Address - Country:US
Practice Address - Phone:702-248-7337
Practice Address - Fax:702-478-5465
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001222363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics