MEDICARE: NADEZHDA ILNITSKAIA

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1528854890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEZHDA ILNITSKAIA

Provider Business Mailing Address
First Line	:	3866 FALCON SPRINGS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4277
Country	:	US
Telephone Number	:	702-463-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 S RAINBOW BLVD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6216
Country	:	US
Telephone Number	:	702-463-0085
Fax Number	:

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

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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Directions to “ NADEZHDA ILNITSKAIA ” Practice Location

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