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Individual

THERESA B. STALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
7050 SMOKE RANCH RD, STE 130, LAS VEGAS, NV 89128-8609
(702) 233-9911
(702) 243-5568
Mailing address
7050 SMOKE RANCH RD, STE 130, LAS VEGAS, NV 89128-8609
(702) 233-9911
(702) 243-5568

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN001380
NV
363LA2100X
Acute Care Nurse Practitioner
1007373
DC
363LA2100X
Acute Care Nurse Practitioner
AP30007643
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0219957
L&I
WA
01
03851U
REGENCE BLUE SHIELD
WA
05
9652496
WA
Enumeration date
02/28/2007
Last updated
05/31/2012
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