Healthcare Provider Details

I. General information

NPI: 1003240979
Provider Name (Legal Business Name): MARWELL VILORIA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GALLERIA DR
HENDERSON NV
89011-4800
US

IV. Provider business mailing address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6948
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number868182
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: