Healthcare Provider Details

I. General information

NPI: 1053394866
Provider Name (Legal Business Name): BETTINA GISELLE ALVAREZ RN,BSN,MSN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CORDERO ROAD
MCDERMITT NV
89421-0315
US

IV. Provider business mailing address

PO BOX 344
MC DERMITT NV
89421-0344
US

V. Phone/Fax

Practice location:
  • Phone: 775-532-4366
  • Fax: 775-532-3664
Mailing address:
  • Phone: 775-532-4366
  • Fax: 775-532-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN89960
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-46038-022
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002392
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: