Individual
TIMOTHY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
330 S LOLA LN, SUITE 200, PAHRUMP, NV 89048-0878
(775) 751-7500
(775) 751-7824
Mailing address
7385 S PECOS RD, STE 103, LAS VEGAS, NV 89120-3768
(888) 221-2297
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA000265
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505726
—
NV
Enumeration date
08/17/2005
Last updated
12/20/2016
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