MEDICARE: IRENA KRASS A-GNP-C

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	814680	NV

General Provider Information

NPI Number	:	1871287748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENA KRASS A-GNP-C

Provider Business Mailing Address
First Line	:	7613 MOJAVE WIND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-4715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7613 MOJAVE WIND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-4715
Country	:	US
Telephone Number	:	702-498-5653
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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