Provider Demographics
NPI:1427708585
Name:PAHRUMP PEDIATRICS LLC
Entity type:Organization
Organization Name:PAHRUMP PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:775-318-9300
Mailing Address - Street 1:2200 E CALVADA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5833
Mailing Address - Country:US
Mailing Address - Phone:775-318-9300
Mailing Address - Fax:775-318-9318
Practice Address - Street 1:2270 COMMERCIAL DR UNIT 2
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4704
Practice Address - Country:US
Practice Address - Phone:775-318-9300
Practice Address - Fax:775-318-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417162561Medicaid
NV1053670190Medicaid