MEDICARE: KHADIJA BILALI-AZZAT NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	861921	NV

General Provider Information

NPI Number	:	1962114843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADIJA BILALI-AZZAT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	801 S RANCHO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3860
Country	:	US
Telephone Number	:	752-217-5628
Fax Number	:	702-331-2035

Provider Business Practice Location Address
First Line	:	801 S RANCHO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3860
Country	:	US
Telephone Number	:	752-217-5628
Fax Number	:	702-331-2035

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

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	12/22/2022

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Directions to “ KHADIJA BILALI-AZZAT NURSE PRACTITIONER” Practice Location

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