Provider Demographics
NPI:1013612092
Name:PRIME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PRIME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-466-4148
Mailing Address - Street 1:6999 BARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5052 S JONES BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0567
Practice Address - Country:US
Practice Address - Phone:702-466-4148
Practice Address - Fax:702-904-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty