Provider Demographics
NPI:1902520307
Name:PITTARI, GRACEANN ASHLEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GRACEANN
Middle Name:ASHLEY
Last Name:PITTARI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S GIBSON RD APT 3304
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2670
Mailing Address - Country:US
Mailing Address - Phone:702-848-5888
Mailing Address - Fax:720-414-0323
Practice Address - Street 1:8565 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2808
Practice Address - Country:US
Practice Address - Phone:702-848-5888
Practice Address - Fax:720-414-0323
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV859121363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health