Healthcare Provider Details

I. General information

NPI: 1154029148
Provider Name (Legal Business Name): KRIZZA ANGELIQUE ANGELES OLONAN MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S RAINBOW BLVD
LAS VEGAS NV
89118-1859
US

IV. Provider business mailing address

6885 DRAGONFLY ROCK ST
LAS VEGAS NV
89148-4311
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-3000
  • Fax:
Mailing address:
  • Phone: 702-524-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTEMP863825
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: