Provider Demographics
NPI:1144063629
Name:DESERT PMHNP, LLC
Entity type:Organization
Organization Name:DESERT PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENTENZA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-553-4105
Mailing Address - Street 1:1031 YELLOW MARIGOLD CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9228
Mailing Address - Country:US
Mailing Address - Phone:702-553-4105
Mailing Address - Fax:
Practice Address - Street 1:1031 YELLOW MARIGOLD CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9228
Practice Address - Country:US
Practice Address - Phone:702-553-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty