MEDICARE: ANTHONY MICHAEL VALIENTE FNP-BC

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	852799	NV

General Provider Information

NPI Number	:	1124769732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY MICHAEL VALIENTE FNP-BC

Provider Business Mailing Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-366-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-366-0640
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	05/12/2022

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