PROVENANCE HEALTHCARE LLC (NPI# 1316322738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316322738 |
| Entity Type | Organization |
| Organization Name | PROVENANCE HEALTHCARE LLC |
| Practice Address |
5155 S Durango Dr Ste 103 Las Vegas NV 89113-0175 |
| Practice Telephone | 7024782524 |
| Practice Fax Number | 7027359074 |
| Mailing Telephone | 7024782524 |
| Mailing Fax Number | 7027359074 |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |
| Authorized Official Name | MARK L BLACK (OWNER OPERATOR) |
| Authorized Official Telephone | 7024782524 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 170300000X | Genetic Counselor, MS | OTHER | NV | Other Service Providers |
| Street Address |
5155 S DURANGO DR STE 103 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89113-0175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457951121 | Trang Thu Tran | Pharmacist | 7200 Arroyo Crossing Parkway, Las Vegas, NV 89113 | 2020-10-30 |
| 1457966293 | Cory Alexander Stattelman | Physical Medicine & Rehabilitation | 5575 N Durango Dr Suite 111, Las Vegas, NV 89113 | 2020-09-09 |
| 1477170801 | Hailey Eileen Wilson | Behavior Technician | 5575 S Durango Dr #102, Las Vegas, NV 89113 | 2020-07-01 |
| 1295385078 | Dominica Zaragoza | Technician | 711 S. Durango Dr, Las Vegas, NV 89113 | 2019-09-13 |
| 1831742758 | Lyass PC A Professional Medical Corp | Clinic/Center | 5950 S. Durgango Dr, Suite 100, Las Vegas, CA 89113 | 2019-07-19 |
| 1932679529 | Kiara Hayden | Rehabilitation Practitioner | 5509 Lonesome Biker Lane, Las Vegas, NV 89113 | 2018-11-27 |
| 1437631876 | James Eugene Hightower | Community Health Worker | 7455 Arroyo Crossing Pkwy Suite 220, Las Vegas, NV 89113 | 2018-09-01 |
| 1356822282 | Warda Ali | Nurse Practitioner | 8738 Pinley Spring St, Las Vegas, NV 89113 | 2018-08-28 |
| 1063992949 | Endure Recovery Services LLC | Counselor | 3087 E. Warm Srpings, Suite 200, Las Vegas, NV 89113 | 2018-08-20 |
| 1134635097 | Mivip Regional Surgery Center | Clinic/Center | 5950 S Durango Dr Ste 101, Las Vegas, NV 89113 | 2017-12-14 |
| Find all providers in zip 89113 | ||||
| Taxonomy Code | 170300000X |
| Grouping | Other Service Providers |
| Classification | Genetic Counselor, MS |
| A masters trained health care provider who collects and interprets genetic family histories; assesses the risk of disease occurrence or recurrence; identifies interventions to manage or ameliorate disease risk; educates about inheritance, testing, management, prevention, ethical issues, resources, and research; and counsels to promote informed choices and adaptation. Certification was established in 1993 by the American Board of Genetic Counseling and prior to that by the American Board of Medical Genetics. Requirements for experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: National Society of Genetic Counselors [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124415625 | Adrianne Baxter | Genetic Counselor, MS | 8300 Spruce Meadows Ave, Las Vegas, NV 89131-4581 | 2015-04-22 |
| 1861648727 | Stephanie E Farner | Genetic Counselor, MS | 7470 Santo Domingo Ave, Las Vegas, NV 89178-8448 | 2008-08-12 |
| 1568684264 | Palo Verde Child and Family Services, Inc | Genetic Counselor, MS | 2801 S Valley View Blvd Ste 14, Las Vegas, NV 89102-0116 | 2007-05-03 |
| 1073591103 | Kristina Fontana | Genetic Counselor, MS | 2040 W Charleston Blvd, 401, Las Vegas, NV 89102-2227 | 2006-01-09 |
| 1750911897 | Jessica Ann Greenwood | Genetic Counselor, MS | 5761 S Fort Apache Rd, Las Vegas, NV 89148-5506 | 2020-01-16 |
| 1205373479 | Amara Lauritzen | Genetic Counselor, MS | 2011 Pinto Ln, Suite 200, Las Vegas, NV 89106-4004 | 2017-01-26 |
| 1962950766 | Lauren Musgrove | Genetic Counselor, MS | 2011 Pinto Ln Ste 200, Las Vegas, NV 89106-4007 | 2016-09-21 |
| 1417350877 | Jeanette Saffir | Genetic Counselor, MS | 2011 Pinto Ln Ste 200, Las Vegas, NV 89106-4007 | 2014-09-30 |
| 1417258617 | Tracey Lynn Gaebe-schulz | Genetic Counselor, MS | 5761 S Fort Apache Rd, Las Vegas, NV 89148-5506 | 2010-11-04 |
| 1922309236 | Teresa Tiberg | Genetic Counselor, MS | 5761 S Fort Apache Rd, Las Vegas, NV 89148-5506 | 2010-11-03 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.