| A Nicknam Pc | |
|
1712 Bearden Dr Las Vegas NV 89106-4107 | |
| (702) 733-6622 | |
| (702) 382-6622 |
| Full Name | A Nicknam Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1712 Bearden Dr, Las Vegas, Nevada |
| Authorized Official Name and Position | Amir K Nicknam (PRESIDENT) |
| Authorized Official Contact | 7027336622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Nicknam Pc Po Box 34717 Las Vegas NV 89133-4717 Ph: (702) 733-6622 | A Nicknam Pc 1712 Bearden Dr Las Vegas NV 89106-4107 Ph: (702) 733-6622 |
| NPI Number | 1659501302 |
|---|---|
| Provider Enumeration Date | 07/15/2009 |
| Last Update Date | 12/31/2013 |
| Medicare PECOS PAC ID | 1052452422 |
|---|---|
| Medicare Enrollment ID | O20100107000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659501302 | NPI | - | NPPES |
| CP615A | Other | NV | MEDICARE PTAN |
| 1659501302 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 11368 (Nevada) | Primary |
| Provider Name | Sana Safaei |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457347304 PECOS PAC ID: 0244257145 Enrollment ID: I20051031000371 |
| Provider Name | Amir Karim Nicknam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063530434 PECOS PAC ID: 4587632468 Enrollment ID: I20081016000293 |
| Provider Name | Rachel L Stolley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124017967 PECOS PAC ID: 8820391998 Enrollment ID: I20160122001769 |
| Provider Name | Meagan Elizabeth Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497397830 PECOS PAC ID: 7618302332 Enrollment ID: I20200127000594 |
| Provider Name | Brandi Bjornstad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104577824 PECOS PAC ID: 6002283108 Enrollment ID: I20221102001744 |
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