Healthcare Provider Details

I. General information

NPI: 1568287555
Provider Name (Legal Business Name): ROBERT ILAGAN ST JEAN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

IV. Provider business mailing address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

V. Phone/Fax

Practice location:
  • Phone: 702-521-4797
  • Fax:
Mailing address:
  • Phone: 702-521-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number827833
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: