Provider Demographics
NPI:1689242190
Name:DIRECT HEALTHCARE OF NEVADA PC
Entity Type:Organization
Organization Name:DIRECT HEALTHCARE OF NEVADA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RILWAN
Authorized Official - Middle Name:OLALEKAN
Authorized Official - Last Name:SHOYOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-846-5978
Mailing Address - Street 1:5353 S JONES BLVD APT 1016
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0539
Mailing Address - Country:US
Mailing Address - Phone:702-846-5978
Mailing Address - Fax:702-846-0305
Practice Address - Street 1:5353 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0537
Practice Address - Country:US
Practice Address - Phone:702-846-5978
Practice Address - Fax:702-846-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty