Provider Demographics
NPI:1972662393
Name:THEUVENET, NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:THEUVENET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 S EASTERN AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2505
Mailing Address - Country:US
Mailing Address - Phone:714-318-5516
Mailing Address - Fax:702-933-0974
Practice Address - Street 1:8275 S EASTERN AVE STE 253
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2505
Practice Address - Country:US
Practice Address - Phone:714-318-5516
Practice Address - Fax:702-933-0974
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019791Medicaid
NVV34801Medicare ID - Type Unspecified
NV002019791Medicaid