Provider Demographics
NPI:1134790660
Name:ADVANCED PRACTICE PSYCHIATRY OF NEVADA LCC
Entity type:Organization
Organization Name:ADVANCED PRACTICE PSYCHIATRY OF NEVADA LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REIMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAFICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-405-7366
Mailing Address - Street 1:1573 DARK WOLF AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1573 DARK WOLF AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4859
Practice Address - Country:US
Practice Address - Phone:702-405-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty