MEDICARE: MAE NEKOBA, LLC

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	363LA2100X	Acute Care Nurse Practitioner

General Provider Information

NPI Number	:	1730936451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAE NEKOBA, LLC

Provider Business Mailing Address
First Line	:	4020 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3802
Country	:	US
Telephone Number	:	702-485-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3802
Country	:	US
Telephone Number	:	702-780-1313
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAE NEKOBA
Credential	:	APRN
Telephone Number	:	702-485-3593

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	09/05/2024

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