Provider Demographics
NPI:1376698001
Name:NOVALIS, PETER NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NICHOLAS
Last Name:NOVALIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 W CHARLESTON BLVD
Mailing Address - Street 2:SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1126
Mailing Address - Country:US
Mailing Address - Phone:702-486-8051
Mailing Address - Fax:702-486-7608
Practice Address - Street 1:6161 W CHARLESTON BLVD
Practice Address - Street 2:SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-8051
Practice Address - Fax:702-486-7608
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV100512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE58104OtherPREVIOUS MEDICARE UPIN