Provider Demographics
NPI:1194238808
Name:NADLER, SHOLOM D (FNP)
Entity type:Individual
Prefix:
First Name:SHOLOM
Middle Name:D
Last Name:NADLER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3376
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9077 S PECOS RD STE 3800
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7182
Practice Address - Country:US
Practice Address - Phone:702-947-1940
Practice Address - Fax:702-947-1966
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002750363L00000X, 363LF0000X
NVTAPRN701731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194238808Medicaid
NVAPRN002750OtherSTATE LICENSE