Healthcare Provider Details

I. General information

NPI: 1457164436
Provider Name (Legal Business Name): JANELLE KIANA BUMAGAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY BLDG 8, STE F
HENDERSON NV
89074
US

IV. Provider business mailing address

3161 SUNRIDGE HEIGHTS PKWY UNIT 1406
HENDERSON NV
89052-5091
US

V. Phone/Fax

Practice location:
  • Phone: 702-661-3438
  • Fax: 725-205-4422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number818995
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: