Provider Demographics
NPI:1215104377
Name:SEVILLA, ATHENI DEGRANO (APRN)
Entity type:Individual
Prefix:
First Name:ATHENI
Middle Name:DEGRANO
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ATHENI
Other - Middle Name:
Other - Last Name:SEVILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4270 S DECATUR BLVD STE B6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6802
Mailing Address - Country:US
Mailing Address - Phone:702-485-2100
Mailing Address - Fax:702-825-0091
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV824000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health