MEDICARE: MYKEL MATTHEWS-DASE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	852237	NV

General Provider Information

NPI Number	:	1033808274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKEL MATTHEWS-DASE

Provider Business Mailing Address
First Line	:	1810 E SAHARA AVE
Second Line	:	SUITE 212 #3166
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2274 ICARUS DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5042
Country	:	US
Telephone Number	:	773-369-8423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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