Provider Demographics
NPI:1326866112
Name:NOSAKHARE, PERPETUAL A
Entity type:Individual
Prefix:
First Name:PERPETUAL
Middle Name:A
Last Name:NOSAKHARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10987 WONDER HILLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6162
Mailing Address - Country:US
Mailing Address - Phone:702-544-8913
Mailing Address - Fax:
Practice Address - Street 1:10987 WONDER HILLS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-6162
Practice Address - Country:US
Practice Address - Phone:702-544-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV824366363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology