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NPI Code Detail

MEDICARE: MS. DENISE HELEN LICINI NP

MEDICARE: MS. DENISE HELEN LICINI NP
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
1363LA2200XAdult Health Nurse PractitionerNC085069NJ
2363L00000XNurse PractitionerNPF21784CA
3363L00000XNurse PractitionerAPRN822758NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3HD702ZOTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121784OTHERCANP
2818601OTHERCARN

General Provider Information

NPI Number : 1902864564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DENISE HELEN LICINI NP
Provider Business Mailing Address
First Line : 705 GRANITE RAPIDS ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-7529
Country : US
Telephone Number : 862-228-0578
Fax Number :
Provider Business Practice Location Address
First Line : 6827 W TROPICANA AVE STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-4920
Country : US
Telephone Number : 702-508-9128
Fax Number : 702-302-4125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 12/09/2022

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Directions to “ MS. DENISE HELEN LICINI NP” Practice Location

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