Provider Demographics
NPI:1417436858
Name:GAIDIS, CAROL KAY
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:KAY
Last Name:GAIDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 W WARM SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4328
Mailing Address - Country:US
Mailing Address - Phone:702-933-5544
Mailing Address - Fax:
Practice Address - Street 1:1552 W WARM SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4328
Practice Address - Country:US
Practice Address - Phone:702-933-5544
Practice Address - Fax:702-933-5545
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily