Provider Demographics
NPI:1689233652
Name:ASSOON-BROADY, SIOBHAN (DNP-PNP)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:ASSOON-BROADY
Suffix:
Gender:F
Credentials:DNP-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 CASCADE VALLEY CT STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1407
Mailing Address - Country:US
Mailing Address - Phone:702-641-2150
Mailing Address - Fax:702-228-1043
Practice Address - Street 1:7180 CASCADE VALLEY CT STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1407
Practice Address - Country:US
Practice Address - Phone:702-641-2150
Practice Address - Fax:702-228-1043
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV817771363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics