Provider Demographics
NPI:1902532336
Name:PRIORITY HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRIORITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-529-0059
Mailing Address - Street 1:10241 ANGELS LOFT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1541
Mailing Address - Country:US
Mailing Address - Phone:702-529-0059
Mailing Address - Fax:702-529-0098
Practice Address - Street 1:3440 W CHEYENNE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8221
Practice Address - Country:US
Practice Address - Phone:702-529-0059
Practice Address - Fax:702-529-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic CareGroup - Multi-Specialty