Active NPI
Dusty Mahealani Willis, LPN
- Licensed Practical Nurse
- Boulder City, NV
National Provider Identifier
1780322644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 835700
- Practice address
- 100 Veterans Memorial Dr
Boulder City, NV 89005-1926 - Phone
- (702) 332-6784
- NPI assigned
- May 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 835700 | NV | Primary |
Addresses
Primary practice location
100 Veterans Memorial Dr
Boulder City, NV 89005-1926
Mailing address
177 Vitale Ave
Henderson, NV 89002-9208
Phone (808) 387-4705
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPN-10376 | Other | HI | HAWAII BOARD OF NURSING - PVL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 835700 | NV | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653091200000",
"number": "1780322644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 VITALE AVE",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890029208",
"telephone_number": "808-387-4705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 VETERANS MEMORIAL DR",
"city": "BOULDER CITY",
"state": "NV",
"postal_code": "890051926",
"telephone_number": "702-332-6784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "DUSTY",
"middle_name": "MAHEALANI",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-21",
"last_updated": "2022-05-21",
"certification_date": "2022-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NV",
"license": "835700",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAWAII BOARD OF NURSING - PVL",
"identifier": "LPN-10376",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.