Healthcare Provider Details

I. General information

NPI: 1992043574
Provider Name (Legal Business Name): MAE BADUA GUERRERO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOW LN STE 106
LAS VEGAS NV
89106-4355
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: 702-826-4757
Mailing address:
  • Phone: 702-998-2816
  • Fax: 702-998-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001487
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: