Healthcare Provider Details

I. General information

NPI: 1104478270
Provider Name (Legal Business Name): MARLENE T UNISA DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 S EASTERN AVE STE 160
HENDERSON NV
89052-3975
US

IV. Provider business mailing address

10001 S EASTERN AVE STE 310
HENDERSON NV
89052-3908
US

V. Phone/Fax

Practice location:
  • Phone: 702-889-8444
  • Fax:
Mailing address:
  • Phone: 702-617-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number821588
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number821588
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: