Provider Demographics
NPI:1376250407
Name:FINISHLINE IV THERAPY
Entity Type:Organization
Organization Name:FINISHLINE IV THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-635-2220
Mailing Address - Street 1:3712 WHITE PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6582
Mailing Address - Country:US
Mailing Address - Phone:702-635-2220
Mailing Address - Fax:
Practice Address - Street 1:3712 WHITE PLAINS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6582
Practice Address - Country:US
Practice Address - Phone:702-635-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FINISHLINE IV THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1841899200Medicaid