Healthcare Provider Details

I. General information

NPI: 1245842285
Provider Name (Legal Business Name): EVELYN REYES APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 E RUSSELL RD
LAS VEGAS NV
89120-3802
US

IV. Provider business mailing address

4020 E RUSSELL RD
LAS VEGAS NV
89120-3802
US

V. Phone/Fax

Practice location:
  • Phone: 702-780-1313
  • Fax: 702-476-9073
Mailing address:
  • Phone: 702-780-1313
  • Fax: 702-476-9073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EVELYN REYES
Title or Position: PRESIDENT
Credential: APRN
Phone: 702-780-1313