Organization
PRIMARY CARE OF SOUTHERN NEVADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY ELAN VAN WAGNER M.D. (OWNER)
(702) 990-0333
Entity
Organization
Contact information
Practice address
2225 VILLAGE WALK DR, SUITE 270, HENDERSON, NV 89052-5679
(702) 993-0333
(702) 990-0336
Mailing address
2225 VILLAGE WALK DR, SUITE 270, HENDERSON, NV 89052-5679
(702) 993-0333
(702) 990-0336
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/29/2006
Last updated
10/23/2007
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