Provider Demographics
NPI:1558757021
Name:BINYANGE, MARTIN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BINYANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E WARM SPRINGS RD, UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4243
Mailing Address - Country:US
Mailing Address - Phone:702-602-5250
Mailing Address - Fax:702-602-5251
Practice Address - Street 1:320 E WARM SPRINGS RD UNIT 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4243
Practice Address - Country:US
Practice Address - Phone:702-602-5250
Practice Address - Fax:702-602-5251
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty