Provider Demographics
NPI:1972311538
Name:ESTELLE, NICHOLAS (APRN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ESTELLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 KASLO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7720
Mailing Address - Country:US
Mailing Address - Phone:239-738-6353
Mailing Address - Fax:
Practice Address - Street 1:1815 E LAKE MEAD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7193
Practice Address - Country:US
Practice Address - Phone:702-960-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV878557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily