Healthcare Provider Details

I. General information

NPI: 1114193620
Provider Name (Legal Business Name): MARIE CAROL REYES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 11/02/2023
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MARKS ST
HENDERSON NV
89014
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-6210
  • Fax: 702-435-7050
Mailing address:
  • Phone: 702-383-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001017
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001017
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: