Provider Demographics
NPI:1366532434
Name:BUTLER, TIKVA DARVISH (RN, APN)
Entity type:Individual
Prefix:
First Name:TIKVA
Middle Name:DARVISH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, APN
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8906 SPANISH RIDGE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1304
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:2860 E. DESERT INN ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-796-9997
Practice Address - Fax:702-796-1440
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV00106363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1366532434Medicaid
NV2402007Medicaid
NVS91819Medicare UPIN