Organization
GOOD SAMARITAN FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY M KIDIAVAYI APRN (NURSE PRACTICTIONER)
(702) 400-0517
Entity
Organization
Contact information
Practice address
4220 SAXTON GREEN AVENUE, LAS VEGAS, NV 89141
(702) 400-0517
Mailing address
4220 SAXTON GREEN AVE, LAS VEGAS, NV 89141-4354
(702) 400-0517
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN002072
NV
Other
Enumeration date
03/07/2016
Last updated
03/07/2016
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