MEDICARE: GINA BALGOYEN 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	163WW0000X	Wound Care Registered Nurse	APRN002688	NV
2	363LF0000X	Family Nurse Practitioner	APRN002688	NV

General Provider Information

NPI Number	:	1891206983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BALGOYEN APRN

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE 8080
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-688-2507
Fax Number	:	725-238-1683

Provider Business Practice Location Address
First Line	:	732 S 6TH ST STE 8080
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-688-2500
Fax Number	:	725-238-1683

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

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	05/18/2026

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