MEDICARE: EARL DANIELLE EUGENIO SALVIEJO

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	363LF0000X	Family Nurse Practitioner	820639	NV

General Provider Information

NPI Number	:	1093371692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL DANIELLE EUGENIO SALVIEJO

Provider Business Mailing Address
First Line	:	1550 W CRAIG RD STE 100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0327
Country	:	US
Telephone Number	:	702-777-3615
Fax Number	:	702-642-0808

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0327
Country	:	US
Telephone Number	:	702-777-3615
Fax Number	:	702-642-0808

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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