Healthcare Provider Details

I. General information

NPI: 1760431357
Provider Name (Legal Business Name): JOANN DOLEEN CORDERO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CHARLESTON BLVD
LAS VEGAS NV
89104-6681
US

IV. Provider business mailing address

10713 CORAL VINE ARBOR AVE
LAS VEGAS NV
89144-4282
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-4006
  • Fax:
Mailing address:
  • Phone: 702-968-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN31193
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: