Healthcare Provider Details

I. General information

NPI: 1346923703
Provider Name (Legal Business Name): REHANNON M FISHER APRN-CNP AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N TENAYA WAY STE 120
LAS VEGAS NV
89128-0479
US

IV. Provider business mailing address

2701 N TENAYA WAY STE 120
LAS VEGAS NV
89128-0479
US

V. Phone/Fax

Practice location:
  • Phone: 702-955-8887
  • Fax:
Mailing address:
  • Phone: 702-955-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number869969
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number869969
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number869969
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: