Healthcare Provider Details

I. General information

NPI: 1710690243
Provider Name (Legal Business Name): ERLENE G CUDIAMAT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 E WARM SPRINGS RD STE 300
LAS VEGAS NV
89120-3180
US

IV. Provider business mailing address

3100 W SAHARA AVE STE 116
LAS VEGAS NV
89102-6001
US

V. Phone/Fax

Practice location:
  • Phone: 702-292-6829
  • Fax: 636-212-9019
Mailing address:
  • Phone: 725-292-6829
  • Fax: 636-212-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number861111
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: