Individual
STANLEY KIDIAVAYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
801 S RANCHO DR STE B1B, LAS VEGAS, NV 89106-3871
(702) 490-2398
(702) 912-2273
Mailing address
801 S RANCHO DR STE B1B, LAS VEGAS, NV 89106-3871
(702) 490-2398
(702) 912-2273
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN002072
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN002072
NV
Other
Enumeration date
03/26/2015
Last updated
01/26/2023
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