Healthcare Provider Details

I. General information

NPI: 1821363854
Provider Name (Legal Business Name): NILDA A BADUA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 S EASTERN AVE
LAS VEGAS NV
89169-3312
US

IV. Provider business mailing address

8936 SPANISH RIDGE AVE
LAS VEGAS NV
89148-1354
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-0909
  • Fax: 702-731-1020
Mailing address:
  • Phone: 702-998-2816
  • Fax: 702-998-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN43410
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001512
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: