Provider Demographics
NPI:1265203889
Name:TIEU, NICHOLAS (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TIEU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6692
Mailing Address - Country:US
Mailing Address - Phone:702-952-3400
Mailing Address - Fax:
Practice Address - Street 1:3730 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3321
Practice Address - Country:US
Practice Address - Phone:702-952-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant