MEDICARE: BRENDA GAILE PRIMERO APRN

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	363LP2300X	Primary Care Nurse Practitioner	APRN002609	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN002609	NV

General Provider Information

NPI Number	:	1831613025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA GAILE PRIMERO APRN

Provider Business Mailing Address
First Line	:	9328 POSEIDON VALLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-5542
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4045 SPENCER ST STE 116
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5246
Country	:	US
Telephone Number	:	702-780-6200
Fax Number	:	888-433-5792

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

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/03/2025

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