Healthcare Provider Details

I. General information

NPI: 1366974446
Provider Name (Legal Business Name): CHRISTINA PICENO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD STE 33
LAS VEGAS NV
89102-1934
US

IV. Provider business mailing address

2820 W CHARLESTON BLVD STE 33
LAS VEGAS NV
89102-1934
US

V. Phone/Fax

Practice location:
  • Phone: 559-352-3387
  • Fax: 702-870-6821
Mailing address:
  • Phone: 559-352-3387
  • Fax: 702-870-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02170768
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: