Individual
DOMINIC MASON ETLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
540 N NELLIS BLVD, LAS VEGAS, NV 89110-5368
(702) 877-5199
Mailing address
509 RUBY VISTA CT, LAS VEGAS, NV 89144-4101
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
74214
NV
363L00000X
Nurse Practitioner
Primary
APRN002559
NV
363LF0000X
Family Nurse Practitioner
002559
NV
363LP2300X
Primary Care Nurse Practitioner
APRN002559
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V59731
MEDICARE
NV
Enumeration date
03/30/2017
Last updated
12/22/2021
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