Provider Demographics
NPI:1386989978
Name:QUIAMZON, MARK (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:QUIAMZON
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 W RUSSELL RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1425
Mailing Address - Country:US
Mailing Address - Phone:702-499-0589
Mailing Address - Fax:702-442-9898
Practice Address - Street 1:9205 W RUSSELL RD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1425
Practice Address - Country:US
Practice Address - Phone:702-499-0589
Practice Address - Fax:702-442-9898
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily