Individual
STACY WAYNE SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4475 S EASTERN AVE, LAS VEGAS, NV 89119-7826
(702) 669-5840
Mailing address
7150 W SUNSET RD, STE 201A, LAS VEGAS, NV 89113-1981
(702) 316-1622
(702) 951-0782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1852
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669996567
—
NV
01
—
V52094
SMA MEDICARE
NV
Enumeration date
08/01/2017
Last updated
07/17/2024
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