Healthcare Provider Details

I. General information

NPI: 1942996749
Provider Name (Legal Business Name): KATE FRAN TEJAMO ESCOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N DURANGO DR
LAS VEGAS NV
89149-4409
US

IV. Provider business mailing address

2121 HUMBLE HOLLOW PL
NORTH LAS VEGAS NV
89084-3165
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-1216
  • Fax:
Mailing address:
  • Phone: 702-672-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN85231
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: