Provider Demographics
NPI:1730936451
Name:MAE NEKOBA, LLC
Entity type:Organization
Organization Name:MAE NEKOBA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEKOBA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-485-3593
Mailing Address - Street 1:4020 E RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3802
Mailing Address - Country:US
Mailing Address - Phone:702-485-3593
Mailing Address - Fax:
Practice Address - Street 1:4020 E RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3802
Practice Address - Country:US
Practice Address - Phone:702-780-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty