Provider Demographics
NPI:1790378453
Name:DUDHIA, AMIBEN (APRN)
Entity Type:Individual
Prefix:
First Name:AMIBEN
Middle Name:
Last Name:DUDHIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 BLUE DIAMOND RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-9257
Mailing Address - Country:US
Mailing Address - Phone:702-463-4411
Mailing Address - Fax:
Practice Address - Street 1:8090 BLUE DIAMOND RD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-9257
Practice Address - Country:US
Practice Address - Phone:702-688-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner