MEDICARE: BRANDI KA YIN LU FNP-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	363L00000X	Nurse Practitioner	847725	NV

General Provider Information

NPI Number	:	1902564016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI KA YIN LU FNP-BC

Provider Business Mailing Address
First Line	:	1595 RED ROCK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1229
Country	:	US
Telephone Number	:	702-501-8189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8510
Country	:	US
Telephone Number	:	702-889-8355
Fax Number	:

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

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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