Van Wagner, Kelly E
Van Wagner, Kelly E is an sole proprietor health care provider with primary practice located at 6380 N. Decatur Blvd Ste 215, N. Las Vegas NV 89084. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Van Wagner, Kelly E can be contacted via phone (702) 948-1145.Contact Information
Primary practice address
6380 N. Decatur Blvd Ste 215
N. Las Vegas NV 89084
Phone: (702) 948-1145
Fax: (702) 949-6206
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 9533 | Nevada |
Profile Details
| NPI number | 1306035571 |
|---|---|
| LBN Legal business name | Van Wagner, Kelly E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 23rd, 2007 |
| Last updated | Feb 13th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306035571 | NPPES |
| Nevada | Other | 9533 | STATE LICENSE |
| Nevada | Other | V114112 | STATE LICENSE |
| Nevada | MEDICAID | 1306035571 | STATE LICENSE |
| Nevada | Other | 1306035571 | STATE LICENSE |
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