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NPI Code Detail

MEDICARE: MAE SUMA NEKOBA MSN, AGACNP-BC, APRN

MEDICARE: MAE SUMA NEKOBA MSN, AGACNP-BC, APRN
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
1163WC0200XCritical Care Medicine Registered Nurse780663CA
2363LA2100XAcute Care Nurse Practitioner814923NV

General Provider Information

NPI Number : 1265887962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAE SUMA NEKOBA MSN, AGACNP-BC, APRN
Provider Business Mailing Address
First Line : 6930 S CIMARRON RD STE 260
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2135
Country : US
Telephone Number : 702-476-9700
Fax Number :
Provider Business Practice Location Address
First Line : 6930 S CIMARRON RD STE 260
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2135
Country : US
Telephone Number : 702-476-9700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2016
Last Update Date : 12/04/2025

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