Individual
JESSICA IDICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 E HARMON AVE, LAS VEGAS, NV 89109-4533
(808) 341-6764
Mailing address
12427 PINETINA ST, LAS VEGAS, NV 89141-3025
(808) 341-6764
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
835143
NV
Other
Enumeration date
02/15/2021
Last updated
02/15/2021
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