Healthcare Provider Details

I. General information

NPI: 1861208035
Provider Name (Legal Business Name): JAMES VIR ABRENICA SALES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N PECOS RD STE 120
HENDERSON NV
89074-7364
US

IV. Provider business mailing address

8888 CATFISH STREAM AVE
LAS VEGAS NV
89178-7203
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-7510
  • Fax: 702-629-7519
Mailing address:
  • Phone: 862-208-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number854288
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number854288
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: