Provider Demographics
NPI:1487199501
Name:ATIYEH, STEPHANIE LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:ATIYEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR STE 512
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0519
Mailing Address - Country:US
Mailing Address - Phone:702-796-7546
Mailing Address - Fax:702-255-3223
Practice Address - Street 1:653 N TOWN CENTER DR STE 512
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0519
Practice Address - Country:US
Practice Address - Phone:702-796-7546
Practice Address - Fax:702-255-3223
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant