Healthcare Provider Details

I. General information

NPI: 1811768898
Provider Name (Legal Business Name): JENNIFER P LAX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOWARD HUGHES PKWY STE 300
LAS VEGAS NV
89169-0946
US

IV. Provider business mailing address

7545 OSO BLANCA RD UNIT 1154
LAS VEGAS NV
89149-1526
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number854975
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: