Provider Demographics
NPI:1053545582
Name:FAMY, DANTE FABIAN (APN)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:FABIAN
Last Name:FAMY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6345
Mailing Address - Country:US
Mailing Address - Phone:702-326-0068
Mailing Address - Fax:
Practice Address - Street 1:7235 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4040
Practice Address - Country:US
Practice Address - Phone:702-791-9040
Practice Address - Fax:702-365-3094
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN1107363LF0000X
NVAPN001107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily