Healthcare Provider Details

I. General information

NPI: 1306658174
Provider Name (Legal Business Name): CANDY NICOLAS MIRAFLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 E WARM SPRINGS RD STE 400
LAS VEGAS NV
89120-3144
US

IV. Provider business mailing address

3348 CASTLEFIELDS DR
NORTH LAS VEGAS NV
89081-6950
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-1260
  • Fax:
Mailing address:
  • Phone: 305-302-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number875854
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: