Healthcare Provider Details

I. General information

NPI: 1205715521
Provider Name (Legal Business Name): NOVA S MUIRENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9996 SHADY GLADE CT
LAS VEGAS NV
89148-1687
US

IV. Provider business mailing address

9996 SHADY GLADE CT
LAS VEGAS NV
89148-1687
US

V. Phone/Fax

Practice location:
  • Phone: 702-861-1254
  • Fax:
Mailing address:
  • Phone: 702-861-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: