Nevada Medicaid Provider Revalidation Report

NPI Revalidation Due Date

Name Provider Type

Provider Type Description Provider Specialty

Phone Address City State ZIP

1275820342 12/04/2019 AUSTRIA VIENNA G 14 Behavioral Health Outpatient Treatment 300 7029519751 3111 S VALLEY VIEW BLVD,STE G101 LAS VEGAS NV 891021750518908 12/04/2019 ARCE-MUNOZ IVAN A 20 Physician, M.D., Osteopath, D.O. 053 7027248777 56 N PECOS RD STE B, HENDERSON NV 890741184868093 12/04/2019 VAGHEFI HOSSEINI REZA 20 Physician, M.D., Osteopath, D.O. 060 7023042144 7391 W CHARLESTON BLVD STE 140, LAS VEGAS NV 891171447503644 12/04/2019 CALIGAGAN ASBEL T 24 Advanced Practice Registered Nurses 023 7023690142 9499 W CHARLESTON BLVD STE 150, LAS VEGAS NV 891171972569333 12/04/2019 GALVIN SUSAN C 20 Physician, M.D., Osteopath, D.O. 053 7025602889 2316 W CHARLESTON BLVD, LAS VEGAS NV 891021265695134 12/04/2019 BAMBHA MONA 20 Physician, M.D., Osteopath, D.O. 060 7023690142 3201 S MARYLAND PKWY STE 400, LAS VEGAS NV 891091629303169 12/04/2019 SILVERTON GROUP LLC 20 Physician, M.D., Osteopath, D.O. 060 8012962113 8TH AVE AND C ST, SALT LAKE CITY UT 841431104179332 12/04/2019 MARSHALL TEENA L 34 Therapy 028 7028041511 7361 PRAIRIE FALCON RD, LAS VEGAS NV 891281578529947 12/04/2019 WALSH PAUL F 20 Physician, M.D., Osteopath, D.O. 111 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171235537325 12/04/2019 AGUILAR CYNTHIA 14 Behavioral Health Outpatient Treatment 302 7028151550 1901 S JONES BLVD, LAS VEGAS NV 891461831524636 12/04/2019 IGERT HALEIGH 14 Behavioral Health Outpatient Treatment 301 7026850620 1721 E CHARLESTON BLVD, LAS VEGAS NV 891041548658917 12/04/2019 BISHOP JORDAN 14 Behavioral Health Outpatient Treatment 301 7028827827 5420 W SAHARA AVE STE 201, LAS VEGAS NV 891461689906703 12/04/2019 LEVIN DIANE 20 Physician, M.D., Osteopath, D.O. 053 7023690142 4880 WYNN RD, LAS VEGAS NV 891031952480428 12/05/2019 EVERITT MELANIE D 20 Physician, M.D., Osteopath, D.O. 139 3034937000 13123 E 16TH AVE, AURORA CO 800451992779060 12/05/2019 KAHN DEBRA 20 Physician, M.D., Osteopath, D.O. 146 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171629397690 12/05/2019 PEDRO P HANI MD PC 20 Physician, M.D., Osteopath, D.O. 149 4695447198 8255 LAS VEGAS BLVD S,UNIT 1721 LAS VEGAS NV 891231972615086 12/05/2019 MEDICAL PLAZA PHARMACY 28 Pharmacy 928 6503263200 211 QUARRY RD STE 108, PALO ALTO CA 943041992944557 12/05/2019 BERNALILLO ACADEMY 63 Residential Treatment Centers (RTC) 963 2568803339 1801 RANDOLPH RD SE, ALBUQUERQUE NM 871061669747564 12/05/2019 PAKZAD ZIMA 20 Physician, M.D., Osteopath, D.O. 053 7023690142 4880 WYNN RD, LAS VEGAS NV 891031992068316 12/05/2019 CARSON VALLEY FAMILY HEALTH CENTER 20 Physician, M.D., Osteopath, D.O. 053 7757824800 1664 US HIGHWAY 395 N STE 201, MINDEN NV 894231952696262 12/05/2019 MOMTAZ POUYA 22 Dentist 079 7022432489 2272 S NELLIS BLVD STE 2, LAS VEGAS NV 891041952696262 12/05/2019 MOMTAZ POUYA 22 Dentist 079 7022432489 2272 S NELLIS BLVD STE 2, LAS VEGAS NV 891049005058704 12/05/2019 GARDEN BREEZE ALZHEIMER VILLA 57 Waiver for Adult Group Care 957 950 GARDEN BREEZE WAY, LAS VEGAS NV 891231508264425 12/05/2019 DAVIS HOLLY 14 Behavioral Health Outpatient Treatment 300 7026269400 4716 ANCHORAGE ST, LAS VEGAS NV 891471558315952 12/08/2019 MULLON DARLENE K 20 Physician, M.D., Osteopath, D.O. 126 7753569393 2385 E PRATER WAY STE 205, SPARKS NV 894341548240310 12/08/2019 SIDDOWAY ROGER L 20 Physician, M.D., Osteopath, D.O. 114 8019443188 368 E RIVERSIDE DR STE A, SAINT GEORGE UT 847901689985905 12/08/2019 ANDRES PATRICIO 22 Dentist 173 7028380707 375 N STEPHANIE ST,BLDG 6 STE 611 HENDERSON NV 890141801145123 12/08/2019 HEARING CARE OF CARSON CITY LTD 76 Audiologist 245 7758859888 408 N ROOP ST, CARSON CITY NV 897011962663161 12/08/2019 VANDERPUT RAEGAN M 20 Physician, M.D., Osteopath, D.O. 139 6025128700 1919 E THOMAS RD, PHOENIX AZ 850161649539297 12/08/2019 COHEN CURTIS FARZIN MEOZ AND SCHWARTZ PL 27 Radiology and Non-Invasive Diagnostic Centers 927 7706932622 655 N TOWN CENTER DR, LAS VEGAS NV 891441619933322 12/08/2019 TAUSCH GLIBERT S 20 Physician, M.D., Osteopath, D.O. 126 7028041574 7751 W FLAMINGO RD STE A100, LAS VEGAS NV 891471740682335 12/08/2019 STARS DENTAL 22 Dentist 822 7028968899 467 E SILVERADO RANCH BLVD,STE 115 LAS VEGAS NV 891831710385679 12/08/2019 GEHRKE ROZY 14 Behavioral Health Outpatient Treatment 302 7027715578 801 S RANCHO DR STE E3B, LAS VEGAS NV 891061093809659 12/08/2019 GLEGHORN ELIZABETH E 20 Physician, M.D., Osteopath, D.O. 139 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171477537363 12/09/2019 PHOENIX BAPTIST HOSPITAL 12 Hospital, Outpatient 912 2000 W BETHANY HOME RD, PHOENIX AZ 850151437112406 12/09/2019 ADDUS HOMECARE 83 Personal Care Services - Intermediary Service Org. 983 6302963400 6128 W SAHARA AVE, LAS VEGAS NV 891461720368624 12/09/2019 JENKINS CHARLOTTE 14 Behavioral Health Outpatient Treatment 301 7026495995 3365 W CRAIG RD STE 25, N LAS VEGAS NV 890321346258456 12/09/2019 ALLEN BRUCE 26 Psychologist 162 9287639999 2681 HWY 95 STE 100, BULLHEAD CITY AZ 864421902130222 12/09/2019 BEAVER VALLEY HOSPITAL 19 Nursing Facility 184 8016424457 2200 E 3300 S, SALT LAKE CITY UT 841091235392770 12/09/2019 SMITH TREVOR P 22 Dentist 173 2087347415 1411 FALLS AVE E STE 1000C, TWIN FALLS ID 833011619992112 12/09/2019 PALMER ZANE 22 Dentist 078 2087347415 1411 FALLS AVE E STE 1000C, TWIN FALLS ID 833011477537363 12/09/2019 PHOENIX BAPTIST HOSPITAL 11 Hospital, Inpatient 911 2000 W BETHANY HOME RD, PHOENIX AZ 850151053546671 12/09/2019 YUKIO UYLY G 20 Physician, M.D., Osteopath, D.O. 053 7025602889 2825 SIENA HEIGHTS DR, HENDERSON NV 890521942428958 12/09/2019 BARDAKCIOGLU OVUNC 20 Physician, M.D., Osteopath, D.O. 058 7029684371 1707 W CHARLESTON BLVD STE 160, LAS VEGAS NV 891021053655969 12/09/2019 YAKOV SHAPOSHNIKOV MD PC 20 Physician, M.D., Osteopath, D.O. 114 7027373337 2020 GOLDRING AVE STE 406, LAS VEGAS NV 891061861755456 12/09/2019 HURLEY ASHLEY 14 Behavioral Health Outpatient Treatment 300 7028151550 1901 S JONES BLVD, LAS VEGAS NV 891461174821144 12/09/2019 DEVORE JESSICA L 34 Therapy 027 7753311199 1610 ROBB DR STE D5, RENO NV 895231518356880 12/09/2019 NOLTE WADE T 34 Therapy 027 4085700510 3870 W ANN RD STE 110, N LAS VEGAS NV 890311811032238 12/10/2019 KIDSPEACE NATIONAL CENTERS INC 63 Residential Treatment Centers (RTC) 963 8008543123 5300 KIDSPEACE DR, OREFIELD PA 180691790050490 12/10/2019 MASON VALLEY PHYSICAL THERAPY INC 34 Therapy 027 7754634500 513 W BRIDGE ST STE E, YERINGTON NV 894471790991107 12/10/2019 LORD RON K 20 Physician, M.D., Osteopath, D.O. 063 4352167032 340 FALCON RIDGE PKWY,STE 400 UNIT 104 MESQUITE NV 890271720286453 12/10/2019 HOPE JASON M 20 Physician, M.D., Osteopath, D.O. 066 8435698495 1350 STARDUST ST STE D, RENO NV 895031437187978 12/10/2019 GRIFFEE MATTHEW J 20 Physician, M.D., Osteopath, D.O. 057 8012133900 30 N 1900 E STE 3C444, SALT LAKE CITY UT 841321316342595 12/10/2019 SCOTT KENDRA M 14 Behavioral Health Outpatient Treatment 301 7025621238 3030 S JONES BLVD STE 110, LAS VEGAS NV 891461194833228 12/10/2019 ZOHNER RONALD M 20 Physician, M.D., Osteopath, D.O. 400 2085525707 1842 1ST ST, IDAHO FALLS ID 834011548241912 12/10/2019 NARASIMHAM ASHWIN 20 Physician, M.D., Osteopath, D.O. 060 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171083012199 12/10/2019 CORKILL JOY 14 Behavioral Health Outpatient Treatment 301 7023362812 2470 WRONDEL WAY STE 275, RENO NV 895021518356591 12/10/2019 PERKIN JULIE C 24 Advanced Practice Registered Nurses 023 7023845101 2000 GOLDRING AVE, LAS VEGAS NV 891061073722260 12/11/2019 MANDAVIA KELLY 77 Physician Assistant 977 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271205922614 12/11/2019 DE FILIPPO ROGER E 20 Physician, M.D., Osteopath, D.O. 156 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271134388432 12/11/2019 SIKAND JENNIFER F 20 Physician, M.D., Osteopath, D.O. 218 8558654435 3001 SAINT ROSE PKWY, HENDERSON NV 890521659532117 12/11/2019 KHAN SALMAN R 20 Physician, M.D., Osteopath, D.O. 149 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271588894125 12/11/2019 DAVIS GABRIELLE T 34 Therapy 219 7022365053 452 E SILVERADO RANCH BLVD,STE 455 LAS VEGAS NV 891831538417522 12/11/2019 CRANDALL TARA 24 Advanced Practice Registered Nurses 023 6025128700 1919 E THOMAS RD RD EAST BLDG, PHOENIX AZ 850161407807639 12/11/2019 BOTT PAUL W 77 Physician Assistant 977 4809889108 16052 S EASTERN AVE STE A, HENDERSON NV 890521659687523 12/11/2019 A-AJAYI MD PLLC 20 Physician, M.D., Osteopath, D.O. 146 7028264942 6039 ELDORA AVE STE E, LAS VEGAS NV 891461619905684 12/11/2019 SPICER MARK A 20 Physician, M.D., Osteopath, D.O. 061 9095583111 25455 BARTON RD, LOMA LINDA CA 923541053755488 12/11/2019 KELLY PAIGE 14 Behavioral Health Outpatient Treatment 301 7026394400 3620 N RANCHO DR STE 111, LAS VEGAS NV 891301336545540 12/11/2019 BETTIS ROSARIO E 14 Behavioral Health Outpatient Treatment 302 7028309740 4780 S ARVILLE ST STE B, LAS VEGAS NV 891031366486227 12/11/2019 COLOHAN AUSTIN R 20 Physician, M.D., Osteopath, D.O. 061 9095583111 25865 BARTON RD, LOMA LINDA CA 923541932163656 12/12/2019 ATRIUM PHARMACY 28 Pharmacy 928 6158243911 260 W MAIN ST STE 103, HENDERSONVILLE TN 370751255592390 12/12/2019 LUEDEMAN MICHAEL S 20 Physician, M.D., Osteopath, D.O. 053 7757263171 700 N SPRING ST, CALIENTE NV 89008

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Nevada Medicaid Provider Revalidation Report

1982953659 12/12/2019 CITY CENTRE PHARMACY 28 Pharmacy 928 7024770311 2290 MCDANIEL ST STE 1-A, N LAS VEGAS NV 890301619219615 12/12/2019 ANDRIKUT JULIA A 34 Therapy 028 3700 GRANT DR, RENO NV 895091528018553 12/12/2019 FACULTY PHYSICIANS AND SURGEONS OF LLUSM 20 Physician, M.D., Osteopath, D.O. 061 9095583111 25455 BARTON RD STE 108A, LOMA LINDA CA 923541558633933 12/12/2019 HUMBOLDT GENERAL HOSPITAL RURAL HEALTH C 17 Special Clinics 180 7756235222 118 E HASKELL ST, WINNEMUCCA NV 894451528223906 12/12/2019 HARRIS HEATHER R 24 Advanced Practice Registered Nurses 400 7022634795 500 E WINDMILL LN STE 125, LAS VEGAS NV 891231376949685 12/12/2019 PATTERSON MISTY 14 Behavioral Health Outpatient Treatment 301 7028880036 3085 S JONES BLVD STE D, LAS VEGAS NV 891461538132576 12/13/2019 TSE ANDREA M 20 Physician, M.D., Osteopath, D.O. 057 9164816800 3315 WATT AVE, SACRAMENTO CA 958211821018292 12/15/2019 REVELO MONICA P 20 Physician, M.D., Osteopath, D.O. 066 8012133900 500 S CHIPETA WAY, SALT LAKE CITY UT 841081235234857 12/15/2019 URATA MARK M 20 Physician, M.D., Osteopath, D.O. 101 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271700043361 12/15/2019 RAMANATHAN ANUSHA 20 Physician, M.D., Osteopath, D.O. 152 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271063711067 12/15/2019 OCHOA KELLY M 20 Physician, M.D., Osteopath, D.O. 111 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271164797452 12/15/2019 JUNG CHRISTINA E 20 Physician, M.D., Osteopath, D.O. 139 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271528336872 12/15/2019 BEHAVIORAL INNOVATION AND GUIDANCE LLC 38 Waiver for Intellectual Disabilities and Related 216 7755250244 1213 IAN CT, SPARKS NV 894341659556991 12/15/2019 LIN YANN-BOR 20 Physician, M.D., Osteopath, D.O. 149 7022339222 10300 W CHARLESTON BLVD,STE 13-342 LAS VEGAS NV 891351700172038 12/15/2019 SAINT DOMINIC HOME HEALTH CARE INC 29 Home Health Agency 929 720 W CHEYENNE AVE STE 210, N LAS VEGAS NV 890301073865630 12/15/2019 BENGOA EYE CARE, LTD. 25 Optometrist 825 7756253937 1050 HANSON ST, WINNEMUCCA NV 894451093957581 12/15/2019 SCHMIDT ROBERT L 20 Physician, M.D., Osteopath, D.O. 066 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321184922312 12/15/2019 CANA HOME HEALTH AGENCY 29 Home Health Agency 929 7023310643 4535 W SAHARA AVE STE 204, LAS VEGAS NV 891021407193121 12/15/2019 CARUNGCONG ARLENE 77 Physician Assistant 977 7023208111 7140 SMOKE RANCH RD STE 150, LAS VEGAS NV 891281376742163 12/15/2019 DANDOLU BHAKTAVATH 20 Physician, M.D., Osteopath, D.O. 074 7029684371 1707 W CHARLESTON BLVD STE 160, LAS VEGAS NV 891021659718906 12/15/2019 TARLTON-HOLMES AMBER 14 Behavioral Health Outpatient Treatment 300 7024873154 3630 N RANCHO DR STE 107, LAS VEGAS NV 891301487726519 12/15/2019 LUCERO JESSICA S 24 Advanced Practice Registered Nurses 400 7022634795 500 E WINDMILL LN STE 125, LAS VEGAS NV 891231760467005 12/15/2019 PENDARVIS RAINE 20 Physician, M.D., Osteopath, D.O. 072 8887271074 2020 PALOMINO LN STE 100, LAS VEGAS NV 891061710386743 12/15/2019 VIDARGAS JANETTE 14 Behavioral Health Outpatient Treatment 302 7028309740 4780 S ARVILLE ST STE B, LAS VEGAS NV 891031114012952 12/15/2019 FUNKE KAI D 22 Dentist 078 7024355015 5015 PYRAMID WAY UNIT 113, SPARKS NV 894361538557467 12/15/2019 COPPEDGE MALIKA N 24 Advanced Practice Registered Nurses 023 7024345114 2255 RENAISSANCE DR STE C, LAS VEGAS NV 891191538557467 12/15/2019 COPPEDGE MALIKA N 24 Advanced Practice Registered Nurses 023 7024345114 2255 RENAISSANCE DR STE C, LAS VEGAS NV 891191619015831 12/15/2019 MISMAS RACHEL A 22 Dentist 078 7758871590 2212 S EASTERN AVE, LAS VEGAS NV 891041801294111 12/15/2019 GOLD JULIA 82 Behavioral Health Rehabilitative Treatment 302 6107998038 1785 E SAHARA AVE STE 445, LAS VEGAS NV 891041285629923 12/15/2019 OLSON ELIS Y 20 Physician, M.D., Osteopath, D.O. 111 8004636628 3186 S MARYLAND PKWY, LAS VEGAS NV 891091790991719 12/16/2019 CHANG TODD P 20 Physician, M.D., Osteopath, D.O. 111 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271629075361 12/16/2019 ROCKY MOUNTAIN CARE-CLEARFIELD 19 Nursing Facility 184 8016932300 1481 E 1450 S, CLEARFIELD UT 840151962760504 12/16/2019 KATHRYN L ECKERT MD PC 20 Physician, M.D., Osteopath, D.O. 112 7753338000 75 PRINGLE WAY STE 909, RENO NV 895021881944197 12/16/2019 ROYAL HEIGHTS LLC 57 Waiver for Adult Group Care 957 7755309328 1875 KINGS ROW, RENO NV 895031578836086 12/16/2019 WINNEMUCCA DIALYSIS 45 End Stage Renal Disease (ESRD) Facility 945 830 FAIRGROUNDS RD, WINNEMUCCA NV 894451952698417 12/16/2019 SPRING VALLEY DIALYSIS 45 End Stage Renal Disease (ESRD) Facility 945 3855 S JONES BLVD, LAS VEGAS NV 891031235484981 12/16/2019 RIGBY MATTHEW 72 Nurse Anesthetist 972 7022553547 9260 W SUNSET RD STE 102, LAS VEGAS NV 891481023350709 12/16/2019 KING KARIE A 77 Physician Assistant 977 7759824590 13945 S VIRGINIA ST STE 632, RENO NV 895111578587895 12/17/2019 ZAMRINI EDWARD 20 Physician, M.D., Osteopath, D.O. 126 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321013147099 12/17/2019 CHUNG GAR W 20 Physician, M.D., Osteopath, D.O. 060 7022563637 3001 SAINT ROSE PKWY, HENDERSON NV 890521982849162 12/17/2019 SHON STEVEN 20 Physician, M.D., Osteopath, D.O. 146 7023470100 9140 W POST RD, LAS VEGAS NV 891481811231491 12/17/2019 SCHULTZ SYNDA B 77 Physician Assistant 977 7029488897 8530 W SUNSET RD STE 250, LAS VEGAS NV 891131235369646 12/17/2019 HIGH DESERT FAMILY MEDICINE INC 20 Physician, M.D., Osteopath, D.O. 053 7753523520 2345 E PRATER WAY STE 301, SPARKS NV 894341902193246 12/17/2019 AFANASEVICH VLADISLAV 20 Physician, M.D., Osteopath, D.O. 920 7756828469 10 E 6TH ST,BATTLE MOUNTAIN MHC BATTLE MOUNTAIN NV 898201598153264 12/17/2019 DORN JESSICA 14 Behavioral Health Outpatient Treatment 301 4196958010 4285 N RANCHO DR STE 130, LAS VEGAS NV 891301164690988 12/18/2019 ANDRAS LINDSAY 20 Physician, M.D., Osteopath, D.O. 064 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900279005057417 12/18/2019 CNC ALZHEIMERS HOME CARE 57 Waiver for Adult Group Care 957 7765 CLEARWOOD AVE, LAS VEGAS NV 891231235104605 12/18/2019 SPIELVOGEL KENNETH H 20 Physician, M.D., Osteopath, D.O. 062 5305435659 2175 SOUTH AVE, S LAKE TAHOE CA 961501255371803 12/18/2019 FEARNLEY BRIAN J 34 Therapy 027 7757863040 555 N ARLINGTON AVE, RENO NV 895031891872180 12/18/2019 ROOSE GEORGE W 77 Physician Assistant 400 7027417779 2904 W HORIZON RIDGE PKWY,STE 200 HENDERSON NV 890521679799266 12/18/2019 TASWELL CARL 20 Physician, M.D., Osteopath, D.O. 920 6161 W CHARLESTON BLVD,SOUTHERN NV ADLT MNTL HLTH SRV LAS VEGAS NV 891461508826272 12/18/2019 THOMAS STUART M 22 Dentist 173 4358435437 220 MILLPOND STE 107, STANSBURY UT 840741508826272 12/18/2019 THOMAS STUART M 22 Dentist 173 4358435437 220 MILLPOND STE 107, STANSBURY UT 840741265528194 12/19/2019 SHIN CATHY E 20 Physician, M.D., Osteopath, D.O. 138 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271184628695 12/19/2019 WONG KENNETH K 20 Physician, M.D., Osteopath, D.O. 131 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271982997300 12/19/2019 SMITH MATTHEW L 20 Physician, M.D., Osteopath, D.O. 139 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271043593296 12/19/2019 ENRIQUE JOSE LACAYO MD LTD 20 Physician, M.D., Osteopath, D.O. 114 7023826970 2010 GOLDRING AVE STE 302, LAS VEGAS NV 891061629327416 12/19/2019 ALLEN DEBBIE 34 Therapy 027 7022274477 366 E MESA VERDE LN, LAS VEGAS NV 891231780861914 12/19/2019 BRUCE SCOTT CRAWFORD MD LTD 20 Physician, M.D., Osteopath, D.O. 062 645 SIERRA ROSE DR STE 204, RENO NV 895111720040520 12/19/2019 KLINGENSMITH DAVID P 20 Physician, M.D., Osteopath, D.O. 057 7028780070 9127 W RUSSELL RD STE 110, LAS VEGAS NV 891481033393194 12/19/2019 VISTA HEALTH 20 Physician, M.D., Osteopath, D.O. 106 9287046000 360 S LOLA LN, PAHRUMP NV 890481033393194 12/19/2019 VISTA HEALTH 20 Physician, M.D., Osteopath, D.O. 106 9287046000 360 S LOLA LN, PAHRUMP NV 890481376880708 12/19/2019 MARLON ANTHONY J 77 Physician Assistant 977 7023690142 4500 W OAKEY BLVD, LAS VEGAS NV 891021376981118 12/20/2019 HA DUKE 20 Physician, M.D., Osteopath, D.O. 400 7024776572 620 SHADOW LN,GRADUATE MEDICAL EDUCATION LAS VEGAS NV 891061619958113 12/22/2019 RUDNITSKY BENJAMIN 20 Physician, M.D., Osteopath, D.O. 125 6029971098 2420 PROFESSIONAL CT STE 150, LAS VEGAS NV 891281679517320 12/22/2019 JENNINGS CHRISTOPHE J 20 Physician, M.D., Osteopath, D.O. 218 2084728118 190 E BANNOCK ST, BOISE ID 837121376519967 12/22/2019 UPPERMAN JEFFREY S 20 Physician, M.D., Osteopath, D.O. 138 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271194912592 12/22/2019 SALINAS DANIELI B 20 Physician, M.D., Osteopath, D.O. 149 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271831212513 12/22/2019 SOHAIL IRFAN 20 Physician, M.D., Osteopath, D.O. 125 6029971098 2850 W HORIZON RIDGE PKWY,STE 100 HENDERSON NV 890521518990415 12/22/2019 DESAI JAY 20 Physician, M.D., Osteopath, D.O. 135 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271932335932 12/22/2019 SRINIVASAN SARANYA 20 Physician, M.D., Osteopath, D.O. 111 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271891940078 12/22/2019 FIRESTONE SUSAN 20 Physician, M.D., Osteopath, D.O. 057 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271720314354 12/22/2019 CANNON JENNIFER M 20 Physician, M.D., Osteopath, D.O. 139 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271366702797 12/22/2019 PATRICK DAVIS PA-C LTD 77 Physician Assistant 877 7029488897 4318 W CHEYENNE AVE, N LAS VEGAS NV 89032

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Nevada Medicaid Provider Revalidation Report

1689086274 12/22/2019 WEIHER ADAM 14 Behavioral Health Outpatient Treatment 301 7756248200 900 W FIRST ST SUITE 120, RENO NV 895031508181124 12/22/2019 ZINATI SARAH 20 Physician, M.D., Osteopath, D.O. 053 7754457561 925 IRONWOOD DR STE 1104, MINDEN NV 894231831431592 12/22/2019 HARRIS TAMARA 14 Behavioral Health Outpatient Treatment 300 7024597500 1735 N NELLIS BLVD, LAS VEGAS NV 891151851781850 12/22/2019 HERNAEZ NICHOLAS C 34 Therapy 027 7028040026 727 N NELLIS BLVD, LAS VEGAS NV 891101326071481 12/22/2019 MATAR MARLA M 20 Physician, M.D., Osteopath, D.O. 057 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271740383611 12/22/2019 NEWTH CHRISTOPHE J 20 Physician, M.D., Osteopath, D.O. 109 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271770686552 12/22/2019 WETZEL RANDALL C 20 Physician, M.D., Osteopath, D.O. 109 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271841359353 12/23/2019 GUPTA ARVIN A 20 Physician, M.D., Osteopath, D.O. 125 6029971098 6970 W PATRICK LN STE 140, LAS VEGAS NV 891131689870487 12/23/2019 VORNICU MARIA D 20 Physician, M.D., Osteopath, D.O. 125 6029971098 2425 N LAMB BLVD STE 120, LAS VEGAS NV 891151992772909 12/23/2019 SANKARAN SUNDAR 20 Physician, M.D., Osteopath, D.O. 125 6029971098 2850 W HORIZON RIDGE PKWY,STE 100 HENDERSON NV 890521295861631 12/23/2019 SYED ZEESHAN F 20 Physician, M.D., Osteopath, D.O. 125 6029971098 2545 S BRUCE ST STE 200, LAS VEGAS NV 891691629343629 12/23/2019 ACTION THERAPEUTICS LLC 34 Therapy 027 7025455055 2629 W HORIZON RIDGE PKWY,STE 100 HENDERSON NV 890521043563984 12/23/2019 KESHISHYAN EDIT 34 Therapy 028 8007471299 6440 SKY POINTE DR STE 140-398, LAS VEGAS NV 891311235212895 12/23/2019 DEVEREUX TEXAS TREATMENT NETWORK 63 Residential Treatment Centers (RTC) 963 2813351000 1150 DEVEREUX DR, LEAGUE CITY TX 775731104181791 12/23/2019 OWYHEE AMBULANCE 32 Ambulance, Air or Ground 932 7757572415 1623 HOSPITAL LOOP, OWYHEE NV 898321992749097 12/23/2019 HODSON ROBERT S 20 Physician, M.D., Osteopath, D.O. 057 7028780070 9127 W RUSSELL RD STE 110, LAS VEGAS NV 891481700123759 12/23/2019 DAVID BARTH MBR 77 Physician Assistant 877 8554582910 9662 WAUKEGAN AVE, LAS VEGAS NV 891481144262668 12/23/2019 MCNAUL DAVID W 20 Physician, M.D., Osteopath, D.O. 218 2084728118 190 E BANNOCK ST, BOISE ID 837121487052239 12/23/2019 STEPHENSON JENNIFER 14 Behavioral Health Outpatient Treatment 301 7022947100 100 SAINT JUDES ST, BOULDER CITY NV 890051861895039 12/23/2019 OGDEN KEMA 14 Behavioral Health Outpatient Treatment 302 7025389474 5860 S PECOS RD BLDG G STE 300, LAS VEGAS NV 891201528036340 12/23/2019 MUNEER ABDUL 20 Physician, M.D., Osteopath, D.O. 060 7025793297 2716 N TENAYA WAY FL 4, LAS VEGAS NV 891281427244771 12/24/2019 RAKE ALYSSA J 20 Physician, M.D., Osteopath, D.O. 109 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271265746523 12/24/2019 RUBIN SARAH S 20 Physician, M.D., Osteopath, D.O. 109 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271790781995 12/24/2019 BROWN ALFRED J 20 Physician, M.D., Osteopath, D.O. 156 7757772061 1995 ERRECART BLVD STE 207, ELKO NV 898011891076758 12/24/2019 THISTLE AMANDA 77 Physician Assistant 977 7027311616 2800 E DESERT INN RD STE 100, LAS VEGAS NV 891211043358724 12/24/2019 NAGODE JENNIFER C 20 Physician, M.D., Osteopath, D.O. 146 5305435659 2201 SOUTH AVE, S LAKE TAHOE CA 961501255619177 12/24/2019 CHAN HOLMAN 20 Physician, M.D., Osteopath, D.O. 064 7028780393 1505 WIGWAM PKWY STE 301, HENDERSON NV 890741558609438 12/24/2019 RELPH JENNIFER L 77 Physician Assistant 977 291 N PECOS RD, HENDERSON NV 890741588060602 12/24/2019 CABULONG GEMMA 82 Behavioral Health Rehabilitative Treatment 302 7022198788 98 E LAKE MEAD PKWY STE 302, HENDERSON NV 890151548322191 12/26/2019 REDWINE STEPHANIE L 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021245561133 12/26/2019 CHANDLER MARY T 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021841520574 12/26/2019 GARVEY CHRISTINE A 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021891090841 12/26/2019 CARREIRO CATHERINE L 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021124319181 12/26/2019 TAYLOR KELLY J 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021780970871 12/26/2019 DOCKERY NANCY L 22 Dentist 187 7028893763 3074 ARVILLE ST, LAS VEGAS NV 891021902864762 12/26/2019 PEACOCK PENNY J 20 Physician, M.D., Osteopath, D.O. 060 8012133900 1743 REDSTONE CENTER DR,STE 115 PARK CITY UT 840981225031792 12/26/2019 PLUNKETT EARL K 20 Physician, M.D., Osteopath, D.O. 400 7023820784 1257 PAIUTE CIR, LAS VEGAS NV 891061114122520 12/27/2019 DONOHUE LEE T 20 Physician, M.D., Osteopath, D.O. 139 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171417066333 12/27/2019 HANGER PROSTHETICS & ORTHOTICS INC 33 DME, Disposable, Prosthetics 933 5316 S WOODROW ST STE 101, SALT LAKE CITY UT 841071144290636 12/28/2019 LAIRD JOHN R JR 20 Physician, M.D., Osteopath, D.O. 106 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171326039918 12/29/2019 SCHAEFER CARRIE M 20 Physician, M.D., Osteopath, D.O. 072 6025128700 1919 E THOMAS RD RD MAIN BLDG, PHOENIX AZ 850161922207638 12/29/2019 ARNDAL LARA J 20 Physician, M.D., Osteopath, D.O. 062 153 PIONEER LN STE B, BISHOP CA 935141073721361 12/29/2019 COMMUNITY OUTREACH MEDICAL CENTER 20 Physician, M.D., Osteopath, D.O. 053 7026573873 1090 E DESERT INN RD STE 200, LAS VEGAS NV 891091548564586 12/29/2019 THOMAS G KOMADINA MD LTD 20 Physician, M.D., Osteopath, D.O. 063 7753236000 1895 PLUMAS ST STE 1, RENO NV 895091467717652 12/29/2019 TONG JASON D 22 Dentist 922 7024575335 2755 S NELLIS BLVD STE 12, LAS VEGAS NV 891211174897888 12/29/2019 PHYSICIANS ONSITE INC 20 Physician, M.D., Osteopath, D.O. 060 6151 VEGAS DR, LAS VEGAS NV 891081538503677 12/29/2019 CALLANTA ROWENA P 24 Advanced Practice Registered Nurses 023 7026316860 1706 W BONANZA RD, LAS VEGAS NV 891061841406899 12/29/2019 FARRER-O'BRYANT ROSA 20 Physician, M.D., Osteopath, D.O. 057 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171770837643 12/29/2019 OLSON JOSEPH M 22 Dentist 400 7023820784 1257 PAIUTE CIR, LAS VEGAS NV 891061619258043 12/29/2019 SAMUEL NATASHA 14 Behavioral Health Outpatient Treatment 301 7029421774 2921 N TENAYA WAY, LAS VEGAS NV 891281619258043 12/29/2019 SAMUEL NATASHA 14 Behavioral Health Outpatient Treatment 301 7029421774 2921 N TENAYA WAY, LAS VEGAS NV 891281508254558 12/29/2019 CHAVARRIA ELIANNE 14 Behavioral Health Outpatient Treatment 302 7753224650 690 E PLUMB LN STE 200, RENO NV 895021891777512 12/30/2019 BOROWSKY ALEXANDER D 20 Physician, M.D., Osteopath, D.O. 066 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171326092867 12/30/2019 LAMBA RAMIT 20 Physician, M.D., Osteopath, D.O. 218 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171578598645 12/30/2019 OKUDA CODY 34 Therapy 027 4085700510 7125 GRAND MONTECITO PKWY, LAS VEGAS NV 891491205105699 12/30/2019 PAUU JERRY 14 Behavioral Health Outpatient Treatment 302 4196958010 4285 N RANCHO DR STE 130, LAS VEGAS NV 891301285801704 12/30/2019 DAYTON JOHN R 20 Physician, M.D., Osteopath, D.O. 111 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321487903589 12/30/2019 NEVADA ENT & HEARING ASSOCIATES LLC 20 Physician, M.D., Osteopath, D.O. 065 7753224589 9770 S MCCARRAN BLVD, RENO NV 895231447500657 12/30/2019 LARSEN KATIE J 34 Therapy 027 8007218202 861 CORONADO CENTER DR STE 201, HENDERSON NV 890521861640658 12/30/2019 LYNCH BERNADETTE N 25 Optometrist 925 4358826452 88 E 700 N STE A, TOOELE UT 840741982625257 12/30/2019 BHULLAR HARMEET K 20 Physician, M.D., Osteopath, D.O. 057 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171306248752 12/30/2019 AMERICAN TOXICOLOGY 43 Laboratory, Pathology Clinical 943 7024524999 3340 SUNRISE AVE STE 105, LAS VEGAS NV 891011336496967 12/31/2019 BOUCHER KAYLA A 34 Therapy 028 7027778687 874 AMERICAN PACIFIC DR, HENDERSON NV 890141114262003 12/31/2019 KRISTI A ASANTE MD PC 20 Physician, M.D., Osteopath, D.O. 060 7024501717 657 N TOWN CENTER DR, LAS VEGAS NV 891441407102056 12/31/2019 PINSON JENNY 24 Advanced Practice Registered Nurses 023 7756875162 1665 OLD HOT SPRINGS RD,STE 150 CARSON MNTAL HLTH CTR CARSON CITY NV 897061104238120 12/31/2019 MORALES MIGUEL R 22 Dentist 922 7023090890 2047 W CHARLESTON BLVD STE 100, LAS VEGAS NV 891021841688645 12/31/2019 LOGHRY ASHLEY E 14 Behavioral Health Outpatient Treatment 301 7756248200 900 W FIRST ST STE 120, RENO NV 895031023007416 12/31/2019 PEARSON ROBERT A 25 Optometrist 400 7023820784 2725 MIRA FLORES AVE, LAS VEGAS NV 891021679546139 01/01/2020 EELLS JAMES R 20 Physician, M.D., Osteopath, D.O. 060 7027963847 7020 SMOKE RANCH RD STE 110, LAS VEGAS NV 891281659436038 01/01/2020 MADDEN KIRIN L 20 Physician, M.D., Osteopath, D.O. 400 515 SHOSHONE CIRCLE, ELKO NV 898011194755835 01/01/2020 CORNELIUS CHERYL J 14 Behavioral Health Outpatient Treatment 306 7022566881 7375 PRAIRIE FALCON RD STE 160, LAS VEGAS NV 891281184721854 01/01/2020 SALAMA MOHAMED E 20 Physician, M.D., Osteopath, D.O. 066 8012139300 50 N MEDICAL DR, SALT LAKE CITY UT 841321285777946 01/01/2020 JAMES ROBERT EELLS MD LTD 20 Physician, M.D., Osteopath, D.O. 060 7027963847 7106 SMOKE RANCH RD STE 110, LAS VEGAS NV 891281083820716 01/01/2020 ANSELMO DEAN M 20 Physician, M.D., Osteopath, D.O. 138 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 90027

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1942408562 01/01/2020 TRAN HUNG C 20 Physician, M.D., Osteopath, D.O. 120 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271649586785 01/01/2020 SKOCDOPOLE VICTORIA C 24 Advanced Practice Registered Nurses 023 7759977524 580 W 5TH ST, RENO NV 895031982907549 01/01/2020 DALE LAURA 14 Behavioral Health Outpatient Treatment 300 7026460188 501 S RANCHO DR STE B10, LAS VEGAS NV 891061619287752 01/01/2020 SCHNOBRICH ELIZABETH 26 Psychologist 162 7028065268 5426 VEGAS DR, LAS VEGAS NV 891081174531891 01/01/2020 APRIA HEALTHCARE LLC 33 DME, Disposable, Prosthetics 933 7248737870 2580 LANDON DR STE H, BULLHEAD CITY AZ 864291316028558 01/01/2020 ADAMS MELISSA K 14 Behavioral Health Outpatient Treatment 306 7023415855 7200 CATHEDRAL ROCK DR STE 120, LAS VEGAS NV 891281073801312 01/01/2020 OGUNBAJO TAOFEEQ O 20 Physician, M.D., Osteopath, D.O. 139 9703957878 801 E WILLIAMS AVE, FALLON NV 894061063825222 01/01/2020 EZYFAST PHARMACY 2 28 Pharmacy 928 7022981701 1701 S CASINO DR, LAUGHLIN NV 890291316213531 01/01/2020 PANTHERX SPECIALTY PHARMACY 28 Pharmacy 928 4122469858 24 SUMMIT PARK DR STE 101, PITTSBURGH PA 152751437189545 01/01/2020 BILASH TIMOTHY D 20 Physician, M.D., Osteopath, D.O. 062 7022553547 5320 S RAINBOW BLVD STE 182, LAS VEGAS NV 891181114334422 01/01/2020 SYNERGY SURGICALISTS INC 20 Physician, M.D., Osteopath, D.O. 064 4062235299 118 E HASKELL ST STE B, WINNEMUCCA NV 894451316299654 01/01/2020 SKILLMAN STACIE 14 Behavioral Health Outpatient Treatment 302 7029920576 3680 N RANCHO DR, LAS VEGAS NV 891301235196015 01/01/2020 BARTON MEMORIAL HOSPITAL 20 Physician, M.D., Osteopath, D.O. 066 5305435930 2170 SOUTH AVE, S LAKE TAHOE CA 961501518355395 01/01/2020 KID DENTAL LLC 22 Dentist 822 7758255005 1301 N MCCARRAN BLVD STE 104, SPARKS NV 894311518355395 01/01/2020 KID DENTAL LLC 22 Dentist 822 7758255005 1301 N MCCARRAN BLVD STE 104, SPARKS NV 894311356767057 01/01/2020 HENPRATANEE SAKUNA 24 Advanced Practice Registered Nurses 023 7024764900 6040 S FORT APACHE RD STE 100, LAS VEGAS NV 891481649669151 01/01/2020 MILENA HERNANDEZ THERAPY LLC 14 Behavioral Health Outpatient Treatment 814 7863268289 3435 W CRAIG RD STE D, N LAS VEGAS NV 890321134360506 01/01/2020 VANDERHOEK MATTHEW D 20 Physician, M.D., Osteopath, D.O. 057 7023690142 9260 W SUNSET RD STE 200, LAS VEGAS NV 891481205021474 01/01/2020 WOOD MINNIE E 24 Advanced Practice Registered Nurses 023 7023808118 1200 S 4TH ST STE 111, LAS VEGAS NV 891041093834020 01/01/2020 MOM'S MEALS 58 Waiver for Persons with Physical Disabilities 204 8667163257 3210 SE CORPORATE WOODS DR, ANKENY IA 500211134551930 01/01/2020 NEVADA HOSPICE CARE LLC 64 Hospice 964 7029120500 6960 OBANNON DR STE 130, LAS VEGAS NV 891171871789370 01/01/2020 NEVADA VISION GROUP 25 Optometrist 825 7756894519 620 SIERRA ROSE DR, RENO NV 895111992110274 01/01/2020 JACKSON CHRISTINE F 25 Optometrist 925 7756894519 620 SIERRA ROSE DR, RENO NV 895111336450881 01/01/2020 FOSTER SUMMER L 25 Optometrist 925 7756894519 620 SIERRA ROSE DR, RENO NV 895111386986206 01/01/2020 ELKO SPINE AND REHABILITATION INSTITUTE 20 Physician, M.D., Osteopath, D.O. 068 7758282873 475 8TH ST, ELKO NV 898011417353301 01/01/2020 MILANZ HOSPITALIST SERVICES INC 20 Physician, M.D., Osteopath, D.O. 060 7024078241 861 CORONADO CENTER DR STE 211, HENDERSON NV 890521104036144 01/01/2020 HENDERSON STEVEN R 77 Physician Assistant 977 7023690142 100 N GREEN VALLEY PKWY,STE 240 HENDERSON NV 890741104036144 01/01/2020 HENDERSON STEVEN R 77 Physician Assistant 977 7023690142 100 N GREEN VALLEY PKWY,STE 240 HENDERSON NV 890741609293638 01/01/2020 RATNASOMA DULIP M 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021003221524 01/01/2020 FANOGA FRANI IAN A 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 LAS VEGAS NV 891021598183345 01/01/2020 ALY ALHUSAIN M 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021205253416 01/01/2020 AHMED BIRJEES 20 Physician, M.D., Osteopath, D.O. 060 7028951696 1707 W CHARLESTON BLVD STE 230, LAS VEGAS NV 891021023351921 01/01/2020 RAJACIC PETER C 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021730421173 01/01/2020 KATS MICHAEL 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021104232065 01/01/2020 DAWOD YASER T 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021700278876 01/01/2020 YBARRA ALYSSA 14 Behavioral Health Outpatient Treatment 301 7756258200 900 W FIRST ST STE 120, RENO NV 895031962829036 01/01/2020 MATTA SIMRANKAUR B 20 Physician, M.D., Osteopath, D.O. 400 7026712246 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021629495759 01/01/2020 AGASTYA MANAS 20 Physician, M.D., Osteopath, D.O. 400 7026712345 1707 W CHARLESTON BLVD STE 230, LAS VEGAS NV 891021174843205 01/01/2020 GIBSON MATTHEW S 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021134547078 01/01/2020 PHAN HA-LINH 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021255673877 01/01/2020 MALALUR PANNAHA G 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 LAS VEGAS NV 891021356768303 01/01/2020 FAROOQUI MUHAMMAD T 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021528301660 01/01/2020 SAKSOUK BASSEL 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021053672006 01/01/2020 GHALILI MAZIAR M 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021881023067 01/01/2020 HERRERA KARINA 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021467794008 01/01/2020 HASAN MOHANAD A 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 LAS VEGAS NV 891021730478520 01/01/2020 TANG YING M 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021891113577 01/01/2020 AHMED MUAZER B 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021689080210 01/01/2020 CHAKFEH EYAS 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021942542428 01/01/2020 NGUYEN NAM N 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021285976662 01/01/2020 ALI ZEINA A 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021134547060 01/01/2020 RAINEY ANTOINETTE D 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,UNIV NEVADA SCHOOL OF MEDICINE LAS VEGAS NV 891021225370679 01/01/2020 EBILANE KEITH A 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021023419033 01/01/2020 HIJAZI MAEN 22 Dentist 922 7024865107 2510 W CHARLESTON BLVD STE F56, LAS VEGAS NV 891021760809818 01/01/2020 PANCHANGAM SUBHASREE 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021952714784 01/01/2020 KENG GHAILA C 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021457742967 01/01/2020 PALM VALLEY ASSISTED LIVING 57 Waiver for Adult Group Care 957 7023687700 5975 W TWAIN AVE, LAS VEGAS NV 891031144305616 01/01/2020 WOLF STEVEN 77 Physician Assistant 400 8015876340 PO BOX 3208, SALT LAKE CITY UT 841101821018854 01/01/2020 HYDE MARK A 77 Physician Assistant 400 8015876340 PO BOX 3208, SALT LAKE CITY UT 841101659554855 01/01/2020 STANLEY CANDACE K 20 Physician, M.D., Osteopath, D.O. 400 2058369923 1221 ALTON DR,ALABAMA CLINICAL SCHOOLS BIRMINGHAM AL 352101992139133 01/01/2020 SMITH LINDSEY S 77 Physician Assistant 400 8015876340 PO BOX 3208, SALT LAKE CITY UT 841101295883775 01/01/2020 NGUYEN CAT-HIEN 22 Dentist 922 7028881220 3650 S EASTERN AVE STE 220, LAS VEGAS NV 891691316362353 01/01/2020 ROSEVEAR STACEY M 77 Physician Assistant 400 8015876340 PO BOX 3208, SALT LAKE CITY UT 841101427476365 01/01/2020 UPPALURU LAKSHMI K 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021043552649 01/01/2020 HAO JENELLE K 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021174865851 01/01/2020 SHAH SHYAM R 20 Physician, M.D., Osteopath, D.O. 400 7026712345 2040 W CHARLESTON BLVD,STE 300 -UNIV NV SCHOOL OF MED LAS VEGAS NV 891021013998947 01/01/2020 BROWN SAMUEL M 20 Physician, M.D., Osteopath, D.O. 060 5121 S COTTONWOOD ST, MURRAY UT 841071003213422 01/01/2020 STANLEY LISA A 24 Advanced Practice Registered Nurses 023 9287580121 1225 HANCOCK RD STE C, BULLHEAD CITY AZ 864421306258116 01/01/2020 CID RODRIGO M 24 Advanced Practice Registered Nurses 023 7287580121 1225 HANCOCK RD STE C, BULLHEAD CITY AZ 864421689084766 01/01/2020 NELSON KIMBERLY R 36 Chiropractor 936 7758298686 5301 LONGLEY LN STE B43, RENO NV 895111386021590 01/01/2020 NEVADA PRIMARY PHYSICIANS GROUP NATH MD 20 Physician, M.D., Osteopath, D.O. 060 7024877055 3590 ALPINE LILY DR, LAS VEGAS NV 891411629139712 01/01/2020 APPLETON CHARLOTTE C 20 Physician, M.D., Osteopath, D.O. 060 7757517835 821 N NELLIS BLVD, LAS VEGAS NV 891101972682292 01/01/2020 ZIMMERMAN ETHAN E 20 Physician, M.D., Osteopath, D.O. 053 7026444673 4357 CORPORATE CENTER DR,STE 450 N LAS VEGAS NV 890301104052653 01/01/2020 KHALIGHI MAZDAK A 20 Physician, M.D., Osteopath, D.O. 066 8012133900 500 S CHIPETA WAY, SALT LAKE CITY UT 84108

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Nevada Medicaid Provider Revalidation Report

1477966752 01/01/2020 QUICK BIODIAGNOSTIC LABORATORY LLC 43 Laboratory, Pathology Clinical 943 8887363611 3950 S EASTERN AVE STE 100, LAS VEGAS NV 891191710937503 01/01/2020 FREDERICK EDWARD F 22 Dentist 400 7757382252 515 SHOSHONE CIRCLE, ELKO NV 898011831281419 01/01/2020 BHATIA PARUL 20 Physician, M.D., Osteopath, D.O. 139 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271245497072 01/01/2020 MCFARREN ALICIA K 20 Physician, M.D., Osteopath, D.O. 142 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271386646826 01/01/2020 BROWN HEIDI L 20 Physician, M.D., Osteopath, D.O. 111 7752893001 1500 AVENUE H, ELY NV 893011710243175 01/01/2020 BRESEE JARED 14 Behavioral Health Outpatient Treatment 301 7756248200 900 W FIRST ST STE 120, RENO NV 895031285798439 01/01/2020 BRILL DIANE E 77 Physician Assistant 400 7757382252 515 SHOSHONE CIRCLE, ELKO NV 898011639189186 01/01/2020 ALBITRE JAMES R 77 Physician Assistant 400 7757382252 515 SHOSHONE CIRCLE, ELKO NV 898011700834991 01/01/2020 TURNER BRYAN W 20 Physician, M.D., Osteopath, D.O. 053 8017167007 835 E 4800 S STE 110, MURRAY UT 841071073603155 01/01/2020 HUTCHISON WILLIAM G 20 Physician, M.D., Osteopath, D.O. 149 7022339222 10300 W CHARLESTON BLVD,STE 13-342 LAS VEGAS NV 891351487780201 01/01/2020 RILEY EDWARD T 20 Physician, M.D., Osteopath, D.O. 057 6504978000 300 PASTEUR DR, STANFORD CA 943051477629178 01/01/2020 SUNG YON K 20 Physician, M.D., Osteopath, D.O. 149 6504978000 300 PASTEUR DR, STANFORD CA 943051689601494 01/01/2020 ZAMANIAN ROHAM T 20 Physician, M.D., Osteopath, D.O. 149 6504978000 300 PASTEUR DR, STANFORD CA 943051972724003 01/01/2020 YOLKEN MARA 24 Advanced Practice Registered Nurses 400 7608732849 153 PIONEER LN STE B, BISHOP CA 935141184810806 01/01/2020 DREW TRACY 24 Advanced Practice Registered Nurses 400 7608732849 153 PIONEER LN STE B, BISHOP CA 935141831633445 01/01/2020 JOLLYS DRUG STORE 33 DME, Disposable, Prosthetics 933 7757263771 800 N SPRING ST, CALIENTE NV 890081013035476 01/01/2020 PAREKH MILAN S 20 Physician, M.D., Osteopath, D.O. 400 7022834182 6440 SKY POINTE DR STE 140-116, LAS VEGAS NV 891311124103809 01/01/2020 LOOSE EVELYN C 20 Physician, M.D., Osteopath, D.O. 057 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321649298928 01/01/2020 KUTCHERA WILLIAM A 20 Physician, M.D., Osteopath, D.O. 060 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321710067277 01/01/2020 WILSON PAUL D 25 Optometrist 925 7756894519 620 SIERRA ROSE DR, RENO NV 895111669552287 01/01/2020 CONKEY JAMES V 25 Optometrist 925 7756894519 620 SIERRA ROSE DR, RENO NV 895111992724975 01/02/2020 NEPHI MEDICAL CLINIC 20 Physician, M.D., Osteopath, D.O. 820 4356233200 48 W 1500 N, NEPHI UT 846481023381753 01/02/2020 SCOPE CLINICAL 34 Therapy 028 7754107832 3195 MILL ST, RENO NV 895021649253329 01/02/2020 FARAH RAMEZ 20 Physician, M.D., Osteopath, D.O. 131 7023171030 7150 W SUNSET RD STE 100, LAS VEGAS NV 891131992049928 01/02/2020 INTEGRICARE RX 28 Pharmacy 928 7758517788 8725 TECHNOLOGY WAY STE B2, RENO NV 895211053651091 01/02/2020 HOUSE CALL DR REGALADO PLLC 20 Physician, M.D., Osteopath, D.O. 060 7028760350 1811 S RAINBOW BLVD STE 108, LAS VEGAS NV 891461659777977 01/02/2020 CARL ANJA C 76 Audiologist 245 7029684371 3150 N TENAYA WAY STE 112, LAS VEGAS NV 891281982002994 01/02/2020 JENSEN ELIZABETH 34 Therapy 219 7024011743 11700 W CHARLESTON BLVD,STE 170S LAS VEGAS NV 891351346667235 01/02/2020 SUGGS TRENT K 20 Physician, M.D., Osteopath, D.O. 400 480 GALLETTI WAY,NORTHERN NV ADULT MNTL HLTH SPARKS NV 894311114124153 01/04/2020 STRONG EDWARD B 20 Physician, M.D., Osteopath, D.O. 065 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171508841537 01/04/2020 LINK DANIEL P JR 20 Physician, M.D., Osteopath, D.O. 072 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171740253178 01/05/2020 STRANGE MAYA P 20 Physician, M.D., Osteopath, D.O. 147 7753230478 1240 E 9TH ST, RENO NV 895121952452492 01/05/2020 CHANCE LAWRENCE 20 Physician, M.D., Osteopath, D.O. 920 6161 W CHARLESTON BLVD,SOUTHERN NV ADLT MNTL HLTH SRV LAS VEGAS NV 891461134144066 01/05/2020 BRENNAN KEVIN C JR 20 Physician, M.D., Osteopath, D.O. 126 8012133900 50 N MEDICAL DR, SALT LAKE CITY UT 841321215235213 01/05/2020 CENTER FOR BEHAVIORAL HEALTH LAS VEGAS I 17 Special Clinics 215 2083679021 3050 E DESERT INN RD STE 116, LAS VEGAS NV 891211902053861 01/05/2020 ASFOUR FADI Y 20 Physician, M.D., Osteopath, D.O. 139 8012133900 100 N MARIO CAPECCHI DR, SALT LAKE CITY UT 841131104175272 01/05/2020 STATEN DEBORHA L 22 Dentist 922 7027367979 5475 S FORT APACHE RD STE 100, LAS VEGAS NV 891481285876797 01/05/2020 AIKIN SHERRI L 24 Advanced Practice Registered Nurses 400 7753529355 645 SIERRA ROSE DR STE 204, RENO NV 895111790099216 01/05/2020 STONDELL FLORA W 24 Advanced Practice Registered Nurses 400 9167342011 4501 X ST FL 2, SACRAMENTO CA 958171922402858 01/05/2020 ZACHRY ALISON D 20 Physician, M.D., Osteopath, D.O. 400 5302511420 1850 SPRING RIDGE DR, SUSANVILLE CA 961301093709404 01/05/2020 KRONER LUDWIG F 20 Physician, M.D., Osteopath, D.O. 064 8888927575 118 E HASKELL ST, WINNEMUCCA NV 894451891930533 01/05/2020 HOWELL JACQUELYN L 24 Advanced Practice Registered Nurses 023 7757510444 1017 E BASIN AVE STE 3, PAHRUMP NV 890601730192196 01/05/2020 RAY NEIL P 20 Physician, M.D., Osteopath, D.O. 057 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171912999764 01/05/2020 IMBUS CHARLES E 20 Physician, M.D., Osteopath, D.O. 126 3233612337 4650 W SUNSET BLVD MS 82, LOS ANGELES CA 900271902202419 01/05/2020 HOBSON PAULA R 24 Advanced Practice Registered Nurses 023 8012133900 1950 CIRCLE OF HOPE DR, SALT LAKE CITY UT 841121639567241 01/05/2020 ROCKMAKER CLAUDIA 14 Behavioral Health Outpatient Treatment 300 7025705200 3550 W CHEYENNE AVE STE 130, N LAS VEGAS NV 890321033532619 01/05/2020 LYNCH LAURA 14 Behavioral Health Outpatient Treatment 305 7022935945 555 CALIFORNIA AVE,BOULDER CITY MNTAL HLTH CLINIC BOULDER CITY NV 890051639455330 01/05/2020 GONZALEZ JACQUELINE 24 Advanced Practice Registered Nurses 023 7759824590 202 LOS ALTOS PKWY, SPARKS NV 894361285703728 01/05/2020 MILLER GLENN G 20 Physician, M.D., Osteopath, D.O. 064 7752893612 1500 AVENUE H, ELY NV 893011811955354 01/05/2020 ASANTE KRISTI A 20 Physician, M.D., Osteopath, D.O. 060 7024501717 657 N TOWN CENTER DR, LAS VEGAS NV 891441982606687 01/05/2020 CHRISTENSEN TODD W 20 Physician, M.D., Osteopath, D.O. 111 8663218433 3186 S MARYLAND PKWY, LAS VEGAS NV 891091811099633 01/05/2020 KOEMPEL JEFFREY A 20 Physician, M.D., Osteopath, D.O. 065 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271275626509 01/05/2020 DEAKERS TIMOTHY W 20 Physician, M.D., Osteopath, D.O. 109 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271598724858 01/05/2020 WEIHER RICHARD G 26 Psychologist 162 7753241988 427 RIDGE ST STE A, RENO NV 895011437214939 01/05/2020 MCEWAN CRAIG M 34 Therapy 027 7757836190 973 MICA DR STE 201, CARSON CITY NV 897051538629928 01/06/2020 MCHENRY JAMI D 58 Waiver for Persons with Physical Disabilities 189 7756360887 1931 MORGAN RD, RENO NV 895211538629928 01/06/2020 MCHENRY JAMI D 58 Waiver for Persons with Physical Disabilities 189 7756360887 1931 MORGAN RD, RENO NV 895211386616332 01/06/2020 BRACKEN RAND N 72 Nurse Anesthetist 972 6608265960 1299 BERTHA HOWE AVE, MESQUITE NV 890271437295599 01/06/2020 CHEN SHIU-YI E 20 Physician, M.D., Osteopath, D.O. 057 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271871693945 01/06/2020 MARACHELIAN ARAZ 20 Physician, M.D., Osteopath, D.O. 120 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271265660047 01/06/2020 JOHN ANSY P 24 Advanced Practice Registered Nurses 023 7026465437 3680 N RANCHO DR, LAS VEGAS NV 891301265660047 01/06/2020 JOHN ANSY P 24 Advanced Practice Registered Nurses 023 7026465437 3680 N RANCHO DR, LAS VEGAS NV 891301356624191 01/06/2020 SANTIAGO CRYSTAL 14 Behavioral Health Outpatient Treatment 300 7029519751 STE 208-8,800 N RAINBOW BLVD LAS VEGAS NV 891071578777157 01/06/2020 SHU JOAN L 20 Physician, M.D., Osteopath, D.O. 111 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271528231511 01/06/2020 VAN METER MARGARET E 20 Physician, M.D., Osteopath, D.O. 131 7753290873 236 W SIXTH ST STE 400, RENO NV 895031841547411 01/06/2020 FAMILY PHARMACY 28 Pharmacy 928 7024136500 4527 W SAHARA AVE, LAS VEGAS NV 891021124300868 01/06/2020 DUTOT RYAN 34 Therapy 027 8007218202 4080 N MARTIN L KING BLVD,STE 101A N LAS VEGAS NV 890321457757577 01/06/2020 INJURY CARE CHIROPRACTIC 36 Chiropractor 836 7022557800 7758 W SAHARA AVE, LAS VEGAS NV 891171992805246 01/06/2020 HOFSTRA THOMAS C 20 Physician, M.D., Osteopath, D.O. 120 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271780855593 01/06/2020 SMITH LAURIE A 24 Advanced Practice Registered Nurses 400 7753529355 645 SIERRA ROSE DR STE 204, RENO NV 895111194982066 01/07/2020 HUNT-LEE NORA 14 Behavioral Health Outpatient Treatment 300 7026296340 6767 W CHARLESTON BLVD STE 150, LAS VEGAS NV 891461710257977 01/07/2020 COAST DENTAL RAINBOW 22 Dentist 822 7026562301 3163 N RAINBOW BLVD, LAS VEGAS NV 891081902087547 01/07/2020 DIXIE HEARING & BALANCE CENTER 76 Audiologist 876 4356888991 340 FALCON RIDGE PKWY BLDG 500, MESQUITE NV 890271295000859 01/07/2020 WALTER JUSTINA L 34 Therapy 027 7752847460 5578 LONGLEY LN, RENO NV 89511

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Nevada Medicaid Provider Revalidation Report

1770733941 01/07/2020 CARTER LAUREN B 34 Therapy 029 7024867670 1161 S VALLEY VIEW BLVD,NEVADA EARLY INTERVENTION SVCS LAS VEGAS NV 891021164810537 01/07/2020 SWINDLING RICHARD SR 14 Behavioral Health Outpatient Treatment 302 7028221556 C/O BEACON POINTE NV LLC,2810 W CHARLESTON BLVD STE 64 LAS VEGAS NV 891021972685212 01/07/2020 PEOPLES RANDAL R 20 Physician, M.D., Osteopath, D.O. 126 6024063860 2865 SIENA HEIGHTS DR STE 131, HENDERSON NV 890521194812438 01/07/2020 VASQUEZ CARLOS M 77 Physician Assistant 977 7025792307 540 N NELLIS BLVD, LAS VEGAS NV 891101003961335 01/08/2020 MCKNIGHT JANET 34 Therapy 028 7025955437 200 S VIRGINIA ST FL 8, RENO NV 895011942626791 01/08/2020 NEVADA RETINA CENTER 20 Physician, M.D., Osteopath, D.O. 820 7027324500 6980 SMOKE RANCH RD STE 110, LAS VEGAS NV 891281154727329 01/08/2020 TEJADA TASHA 14 Behavioral Health Outpatient Treatment 302 7025705100 2700 E SUNSET RD STE B40, LAS VEGAS NV 891201962688572 01/08/2020 HARPER JEANNE M 34 Therapy 028 7757863040 3700 GRANT DR, RENO NV 895091497143911 01/08/2020 SPENCER LAKESHA L 14 Behavioral Health Outpatient Treatment 302 7024326463 3670 N RANCHO DR STE 108, LAS VEGAS NV 891301053354597 01/08/2020 DIAZ RODNEY C 20 Physician, M.D., Osteopath, D.O. 065 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171780660506 01/08/2020 PATIN CHRISTOPHE T 20 Physician, M.D., Osteopath, D.O. 053 7753296300 1055 S WELLS AVE, RENO NV 895021619008281 01/09/2020 DIAZ DENISE 14 Behavioral Health Outpatient Treatment 305 7753428115 2370 ALMOND CREEK DR, RENO NV 895231386764116 01/09/2020 TAMBURRINO HEATHER L 77 Physician Assistant 977 4809889108 10652 S EASTERN AVE STE A, HENDERSON NV 890521215019641 01/09/2020 DAVID ELMER S 20 Physician, M.D., Osteopath, D.O. 139 7027330744 4043 E SUNSET RD, HENDERSON NV 890141215019641 01/09/2020 DAVID ELMER S 20 Physician, M.D., Osteopath, D.O. 139 7027330744 4043 E SUNSET RD, HENDERSON NV 890141649523796 01/09/2020 AFSHAR RAMI 77 Physician Assistant 977 7757707600 5070 ION DR STE 100, SPARKS NV 894361013953579 01/09/2020 WOLDESENBET MESFIN 20 Physician, M.D., Osteopath, D.O. 067 8004636628 3001 SAINT ROSE PKWY, HENDERSON NV 890521750789954 01/09/2020 STEED STACI L 24 Advanced Practice Registered Nurses 023 8663892727 2662 W HORIZON RIDGE PKWY, HENDERSON NV 890521265860456 01/09/2020 HUMBOLDT PHYSICAL THERAPY & FITNESS INC 34 Therapy 027 7756234813 135 W 2ND ST, WINNEMUCCA NV 894451871573915 01/09/2020 REYNOLDS DEANN 77 Physician Assistant 977 7758538888 800 S MEADOWS PKWY STE 400, RENO NV 895211205993557 01/09/2020 HILLYER ANDREW C 34 Therapy 027 7756234813 135 W 2ND ST, WINNEMUCCA NV 894451295134260 01/10/2020 JOHNSON DEREK 14 Behavioral Health Outpatient Treatment 302 7022947100 100 SAINT JUDES ST, BOULDER CITY NV 890051730279092 01/12/2020 MESQUITE BEHAVIORAL HEALTH CENTER 14 Behavioral Health Outpatient Treatment 814 7023464696 61 N WILLOW ST STE 4, MESQUITE NV 890271770796427 01/12/2020 RAHIMZADEH NARIMAN 20 Physician, M.D., Osteopath, D.O. 057 7028780070 1 E LIBERTY ST STE 555, RENO NV 895011023213899 01/12/2020 WINTHROP BRETT E 20 Physician, M.D., Osteopath, D.O. 057 7028780070 1 E LIBERTY ST STE 555, RENO NV 895011649442609 01/12/2020 MARTIN MATTHEW 20 Physician, M.D., Osteopath, D.O. 053 7027773179 874 AMERICAN PACIFIC DR, HENDERSON NV 890141487836748 01/12/2020 IZADMANESH FAEZEH 20 Physician, M.D., Osteopath, D.O. 053 7022422737 201 N BUFFALO DR, LAS VEGAS NV 891451609070341 01/12/2020 ZACHARIAS-SIMPSON JULIE A 20 Physician, M.D., Osteopath, D.O. 116 7027773197 874 AMERICAN PACIFIC DR, HENDERSON NV 890141417234741 01/12/2020 MOSS VICKI M 34 Therapy 029 7754107832 3195 MILL ST, RENO NV 895021346596467 01/12/2020 BRANNAN STEFANIE L 34 Therapy 029 7757428635 1431 FRAUN CT, SPARKS NV 894361356436661 01/12/2020 ANDERSON BRIAN K 25 Optometrist 925 7026453211 3200 SOARING GULLS DR STE 104, LAS VEGAS NV 891291922359272 01/12/2020 ARCENAS RICHARD A 24 Advanced Practice Registered Nurses 023 8009623303 102 E LAKE MEAD PKWY, HENDERSON NV 890151922359272 01/12/2020 ARCENAS RICHARD A 24 Advanced Practice Registered Nurses 023 8009623303 102 E LAKE MEAD PKWY, HENDERSON NV 890151477535169 01/12/2020 CRAMER JOSEPH J 20 Physician, M.D., Osteopath, D.O. 139 8016621262 3741 W 12600 S, RIVERTON UT 840651295089852 01/12/2020 HAIDER,TING, AND CHUNG, LLC 22 Dentist 078 7025222269 7250 S DURANGO DR STE 110, LAS VEGAS NV 891131326446386 01/12/2020 COMMUNITY HEALTH ALLIANCE-WOOSTER 17 Special Clinics 181 7753296300 680 S ROCK BLVD, RENO NV 895021063504504 01/12/2020 COONEY JAMES R 20 Physician, M.D., Osteopath, D.O. 057 7022553547 6900 N DURANGO DR, LAS VEGAS NV 891491386622462 01/12/2020 MARTIN SCOTT M 20 Physician, M.D., Osteopath, D.O. 134 7029799910 8352 W WARM SPRINGS RD FL 3, LAS VEGAS NV 891131457758328 01/12/2020 LAWSON DIONNE 14 Behavioral Health Outpatient Treatment 302 7028880036 3085 S JONES BLVD STE D, LAS VEGAS NV 891461255533857 01/12/2020 VOGEL ALEXANDER R 20 Physician, M.D., Osteopath, D.O. 072 7758231988 1155 MILL ST, RENO NV 895021033298609 01/12/2020 BOOK LINDA S 20 Physician, M.D., Osteopath, D.O. 139 8012133900 100 N MARIO CAPECCHI DR, SALT LAKE CITY UT 841131477675486 01/12/2020 CORNELL DENISE B 24 Advanced Practice Registered Nurses 023 7753981981 5250 NEIL RD STE 207, RENO NV 895021548221583 01/13/2020 ELLIS ERIN M 24 Advanced Practice Registered Nurses 023 7025602889 888 W BONNEVILLE AVE, LAS VEGAS NV 891061972813103 01/13/2020 ROBERTS DON C 14 Behavioral Health Outpatient Treatment 300 5135 CAMINO AL NORTE STE 287, N LAS VEGAS NV 890311578840724 01/13/2020 CAREMORE MEDICAL GROUP OF NEVADA 20 Physician, M.D., Osteopath, D.O. 060 7023203627 3121 S MARYLAND PKWY,STE 100 101 & 104 LAS VEGAS NV 891099005057391 01/13/2020 SUMMERLIN RETIREMENT HOME 57 Waiver for Adult Group Care 957 309 LA RUE CT, LAS VEGAS NV 891459005057490 01/13/2020 RENO VALLEY ASSISTED LIVING & RETIREMENT 57 Waiver for Adult Group Care 957 7753231911 1155 BEECH ST, RENO NV 895121306961644 01/13/2020 HAMILTON ANITA 26 Psychologist 161 3233612337 4650 W SUNSET BLVD, LOS ANGELES CA 900271699703512 01/13/2020 MCGINLEY LAURIE D 24 Advanced Practice Registered Nurses 023 7753237500 645 N ARLINGTON AVE STE 525, RENO NV 895031164605044 01/13/2020 GOOD SHEPHERD REHABILITATION INSTITUTE 34 Therapy 027 7028390091 7375 PRAIRIE FALCON RD STE 120, LAS VEGAS NV 891281093914806 01/13/2020 CAMPBELL DONALD 26 Psychologist 926 7756875162 415 US HIGHWAY 95A S BLDG I, FERNLEY NV 894081386669679 01/13/2020 HAMMOND JASON 20 Physician, M.D., Osteopath, D.O. 057 7757869666 520 HAMMILL LN, RENO NV 895111649673716 01/13/2020 LAWSON JOY 14 Behavioral Health Outpatient Treatment 302 7756248200 900 W FIRST ST STE 120, RENO NV 895031972781656 01/13/2020 LASSEIGNE CHAZ M 72 Nurse Anesthetist 972 7023690142 9260 W SUNSET RD STE 200, LAS VEGAS NV 891481962791806 01/13/2020 PATTON RODNEY 14 Behavioral Health Outpatient Treatment 302 7028151550 1901 S JONES BLVD, LAS VEGAS NV 891461053516542 01/14/2020 NGUYEN QUANG 20 Physician, M.D., Osteopath, D.O. 112 7026055750 229 N PECOS RD STE 100, HENDERSON NV 890741053516542 01/14/2020 NGUYEN QUANG 20 Physician, M.D., Osteopath, D.O. 112 7026055750 229 N PECOS RD STE 100, HENDERSON NV 890741881961977 01/14/2020 CHEYENNE DIALYSIS 45 End Stage Renal Disease (ESRD) Facility 945 3291 N BUFFALO DR BLDG A,STE 150 LAS VEGAS NV 891291073859930 01/14/2020 DIAGNOSTIC LABORATORIES 43 Laboratory, Pathology Clinical 943 8005491880 7355 PRAIRIE FALCON RD, LAS VEGAS NV 891281508120940 01/14/2020 KELLER JENNIFER M 24 Advanced Practice Registered Nurses 023 7753232080 5590 KIETZKE LN, RENO NV 895111306072640 01/14/2020 ODABAEI GOLAUN 20 Physician, M.D., Osteopath, D.O. 125 9167349200 2315 STOCKTON BLVD, SACRAMENTO CA 958171184053894 01/14/2020 JONES MORGAN R 77 Physician Assistant 977 6025128700 1919 E THOMAS RD FL 2, PHOENIX AZ 850161740418391 01/14/2020 AGBAYANI RHEA M 34 Therapy 027 7028040026 3175 SAINT ROSE PKWY STE 331, HENDERSON NV 890521306006861 01/14/2020 MORURI SUSAN N 20 Physician, M.D., Osteopath, D.O. 057 7023951671 2501 N GREEN VALLEY PKWY,STE 112D HENDERSON NV 890141558387449 01/15/2020 HIGGINS DIANNE 20 Physician, M.D., Osteopath, D.O. 111 2094917710 88