Healthcare Provider Details

I. General information

NPI: 1164987871
Provider Name (Legal Business Name): BRENDA PRIMERO NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 BLUE DIAMOND RD
LAS VEGAS NV
89139-7695
US

IV. Provider business mailing address

5155 BLUE DIAMOND RD
LAS VEGAS NV
89139-7695
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-5561
  • Fax: 702-956-9016
Mailing address:
  • Phone: 702-882-5561
  • Fax: 702-956-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA PRIMERO
Title or Position: PRESIDENT
Credential: APRN, NP-C, PMHNP-BC
Phone: 702-882-5561