Healthcare Provider Details

I. General information

NPI: 1003672072
Provider Name (Legal Business Name): VANESSA BELTRAN MARIASIS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 142
LAS VEGAS NV
89146-1050
US

IV. Provider business mailing address

15105D JOHN J DELANEY DR # 193
CHARLOTTE NC
28277-2741
US

V. Phone/Fax

Practice location:
  • Phone: 702-440-8430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number838267
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: