Provider Demographics
NPI:1477633584
Name:GOYA, IRENE (APRN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GOYA
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 1:4000 E CHARLESTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6659
Mailing Address - Country:US
Mailing Address - Phone:702-968-4000
Mailing Address - Fax:702-968-4040
Practice Address - Street 1:4000 E CHARLESTON BLVD
Practice Address - Street 2:SUITE B230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6659
Practice Address - Country:US
Practice Address - Phone:702-968-4000
Practice Address - Fax:702-968-4040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN52641163WP0808X
NVAPRN 001775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health