Individual ProviderDominique NimallahNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1524 Pinto Ln Fl 2, Las Vegas, NV 89106-4195(702) 992-6888(702) 780-2311PECOS EnrollmentBased on the most recent information from CMS, provider Dominique Nimallah is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1528505427Provider TypeIndividualFull NameNimallah, DominiqueGenderFemaleSole ProprietorYesEnumeration Date1/30/2017Last Updated5/10/2024Contact InformationPractice LocationPractice Address1524 Pinto Ln Fl 2, Las Vegas, NV 89106-4195Phone(702) 992-6888Fax(702) 676-3621Mailing LocationMailing Address3016 W Charleston Blvd Ste 100, Las Vegas, NV 89102-1973Phone(702) 780-2311FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense871748NevadaCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer