Provider Demographics
NPI:1811148927
Name:GIDVANI, JULIE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GIDVANI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:5970 S RAINBOW
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-363-4000
Mailing Address - Fax:702-362-0086
Practice Address - Street 1:5970 S RAINBOW
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-363-4000
Practice Address - Fax:702-362-0086
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTAPN700470363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily