Individual
MR. MICHAEL TODD MATHISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC
Contact information
Practice address
4270 S DECATUR BLVD STE B6, LAS VEGAS, NV 89103-6802
(702) 485-2100
(702) 902-2466
Mailing address
7171 ALMERTA AVE, LAS VEGAS, NV 89178-8032
(610) 883-2862
(702) 902-8466
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
818912
NV
Other
Enumeration date
03/20/2019
Last updated
03/20/2019
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