MEDICARE: CONNIE N DOUGLASS 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	363LF0000X	Family Nurse Practitioner	893727	NV

General Provider Information

NPI Number	:	1255069688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE N DOUGLASS NP

Provider Business Mailing Address
First Line	:	4900 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3505
Country	:	US
Telephone Number	:	725-205-4063
Fax Number	:	702-920-7625

Provider Business Practice Location Address
First Line	:	4900 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3505
Country	:	US
Telephone Number	:	725-205-4063
Fax Number	:	702-920-7625

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	03/12/2026

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Directions to “ CONNIE N DOUGLASS NP” Practice Location

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