Provider Demographics
NPI:1548754690
Name:NOVA HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:NOVA HEALTHCARE GROUP LLC
Other - Org Name:NOVA HEALTHCARE GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNELEISA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:702-268-8900
Mailing Address - Street 1:175 CROOKED PUTTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5228
Mailing Address - Country:US
Mailing Address - Phone:702-268-8900
Mailing Address - Fax:702-664-6729
Practice Address - Street 1:175 CROOKED PUTTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5228
Practice Address - Country:US
Practice Address - Phone:702-268-8900
Practice Address - Fax:702-664-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002927363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760723092Medicaid