Healthcare Provider Details

I. General information

NPI: 1184588758
Provider Name (Legal Business Name): GERELYNNE TABION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 BOULDER HWY
LAS VEGAS NV
89122-6074
US

IV. Provider business mailing address

6304 YUCCA VALLEY CT
LAS VEGAS NV
89142-7918
US

V. Phone/Fax

Practice location:
  • Phone: 702-547-6764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number867809
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: