MEDICARE: MARIA LOURDES ROY NP

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	APRN00274	NV

General Provider Information

NPI Number	:	1124471099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LOURDES ROY NP

Provider Business Mailing Address
First Line	:	7038 PLACID LAKE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1524
Country	:	US
Telephone Number	:	410-916-5947
Fax Number	:

Provider Business Practice Location Address
First Line	:	6045 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2572
Country	:	US
Telephone Number	:	702-444-7940
Fax Number	:

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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