Provider Demographics
NPI:1841720521
Name:VON HOLTEN, DUSTIN BRADFORD (PMHNP)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BRADFORD
Last Name:VON HOLTEN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2506
Mailing Address - Country:US
Mailing Address - Phone:347-573-9479
Mailing Address - Fax:347-745-5913
Practice Address - Street 1:5940 S. RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS NV 89118
Practice Address - State:NV
Practice Address - Zip Code:89118-2506
Practice Address - Country:US
Practice Address - Phone:347-573-9479
Practice Address - Fax:347-745-5913
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV871465163WP0808X, 363LP0808X
WARN61447966163WP0808X
NY717042163WP0808X
AK213913163WP0808X
CA95345342163WP0808X
NJ26NR22994400163WP0808X
UT13591362-3102163WP0808X
NY402408363LP0808X
AK213914363LP0808X
CA95027838363LP0808X
WAAP61467436363LP0808X
NJ26NJ01214100363LP0808X
UT13591362-4405363LP0808X
MECNP231481363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health