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NPI Code Detail

MEDICARE: MARIE JOSEPHINE RUPP LPN

MEDICARE: MARIE JOSEPHINE RUPP LPN
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
1164W00000XLicensed Practical Nurse870709NV
2164W00000XLicensed Practical Nurse310785NY

General Provider Information

NPI Number : 1518308345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE JOSEPHINE RUPP LPN
Provider Business Mailing Address
First Line : 4040 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0810
Country : US
Telephone Number : 631-846-4235
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0810
Country : US
Telephone Number : 631-846-4235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2013
Last Update Date : 05/21/2024

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Directions to “ MARIE JOSEPHINE RUPP LPN” Practice Location

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