MEDICARE: ROSE MARIE MCINTOSH FNPC CS

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	363L00000X	Nurse Practitioner	0024114970	VA
2	363L00000X	Nurse Practitioner	13826	CA
3	363LF0000X	Family Nurse Practitioner	819101	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8919101	OTHER	NV	STATE LICENSE
2	ZZZ31887Z	OTHER	CA	CORPORATE PTAN NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063470417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MARIE MCINTOSH FNPC CS

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	821 N NELLIS BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5387
Country	:	US
Telephone Number	:	702-438-4003
Fax Number	:	702-438-0555

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/16/2019

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Directions to “ ROSE MARIE MCINTOSH FNPC CS” Practice Location

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