Provider Demographics
NPI:1518435379
Name:DYTHAVON, NOOR A (RN, MSN, NP)
Entity Type:Individual
Prefix:
First Name:NOOR
Middle Name:A
Last Name:DYTHAVON
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 N MCCARRAN BLVD STE 115-288
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2059
Mailing Address - Country:US
Mailing Address - Phone:916-595-8555
Mailing Address - Fax:
Practice Address - Street 1:10580 N MCCARRAN BLVD
Practice Address - Street 2:SUITE 115-288
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1896
Practice Address - Country:US
Practice Address - Phone:916-595-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017773363LF0000X
CA488218163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care