MEDICARE: MISS MARICLAR V OSORIO APRN, PMHNP-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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	881677	NV

General Provider Information

NPI Number	:	1669717732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARICLAR V OSORIO APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	6847 W CHARLESTON BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1648
Country	:	US
Telephone Number	:	725-205-1578
Fax Number	:	725-485-3749

Provider Business Practice Location Address
First Line	:	6847 W CHARLESTON BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1648
Country	:	US
Telephone Number	:	725-205-1578
Fax Number	:	725-485-3749

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

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	11/08/2024

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