Provider Demographics
NPI:1790129062
Name:ZELLUYAH GAITHO APN GNP PC
Entity Type:Organization
Organization Name:ZELLUYAH GAITHO APN GNP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ZELLUYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-569-5410
Mailing Address - Street 1:10161 PARK RUN DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8872
Mailing Address - Country:US
Mailing Address - Phone:702-569-5410
Mailing Address - Fax:
Practice Address - Street 1:10161 PARK RUN DR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8872
Practice Address - Country:US
Practice Address - Phone:702-569-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001242363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFC725XMedicare PIN