Individual
KIM GENET MOFFATT-BAZILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
3121 S. MARYLAND PKWY, SUITE 220, LAS VEGAS, NV 89109
(702) 732-1493
(702) 732-1080
Mailing address
747 52ND ST, HEMO/ONCOLOGY DEPT, OAKLAND, CA 94609-1809
(510) 428-3372
(510) 597-7199
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
APRN001811
NV
163WP0200X
Pediatric Registered Nurse
RN80724
NV
363L00000X
Nurse Practitioner
Primary
8485
CA
Other
Enumeration date
02/23/2007
Last updated
05/16/2019
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