Healthcare Provider Details

I. General information

NPI: 1205466752
Provider Name (Legal Business Name): ANGELA RUPP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 142
LAS VEGAS NV
89146-1050
US

IV. Provider business mailing address

6600 W CHARLESTON BLVD STE 142
LAS VEGAS NV
89146-1050
US

V. Phone/Fax

Practice location:
  • Phone: 702-440-8430
  • Fax:
Mailing address:
  • Phone: 702-440-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number828006
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3-002138
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number828006
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: