Provider Demographics
NPI:1285970855
Name:MAI, JESSE THI (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:THI
Last Name:MAI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:MAI
Other - Last Name:RONQUILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:4324 S EASTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6064
Mailing Address - Country:US
Mailing Address - Phone:702-405-8500
Mailing Address - Fax:702-405-8501
Practice Address - Street 1:3227 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3180
Practice Address - Country:US
Practice Address - Phone:702-222-0034
Practice Address - Fax:702-222-0659
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner