Provider Demographics
NPI:1316487325
Name:BATEMAN, NADIYA-LARISSA (PA)
Entity type:Individual
Prefix:
First Name:NADIYA-LARISSA
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 W CHARLESTON BLVD # 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1998
Mailing Address - Country:US
Mailing Address - Phone:702-476-9999
Mailing Address - Fax:
Practice Address - Street 1:2809 W CHARLESTON BLVD # 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1998
Practice Address - Country:US
Practice Address - Phone:702-476-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1829363AM0700X
NVPA0575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical