MEDICARE: ALOYCHA LI DE LA ROCHE APRN,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	363LG0600X	Gerontology Nurse Practitioner	APN000937	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN000937	NV

General Provider Information

NPI Number	:	1568469773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALOYCHA LI DE LA ROCHE APRN,BC

Provider Business Mailing Address
First Line	:	6100 IRON KETTLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1065
Country	:	US
Telephone Number	:	702-308-0457
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 IRON KETTLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1065
Country	:	US
Telephone Number	:	702-308-0457
Fax Number	:

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	11/30/2016

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