Organization
INNOVATIVE MT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH TAM (PRACTICE MANAGER)
(702) 706-2804
Entity
Organization
Contact information
Practice address
7395 DESERTSCAPE AVE, LAS VEGAS, NV 89178-8800
(702) 706-2804
(512) 590-7104
Mailing address
7395 DESERTSCAPE AVE, LAS VEGAS, NV 89178-8800
(702) 706-2804
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN002484
NV
Other
Enumeration date
07/25/2017
Last updated
07/21/2022
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