Healthcare Provider Details

I. General information

NPI: 1063388841
Provider Name (Legal Business Name): GENISHA ROSE TIU SALCEDO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 N MLK BLVD
NORTH LAS VEGAS NV
89032-3205
US

IV. Provider business mailing address

4040 N MLK BLVD
NORTH LAS VEGAS NV
89032-3205
US

V. Phone/Fax

Practice location:
  • Phone: 702-353-8972
  • Fax: 702-902-5443
Mailing address:
  • Phone: 702-353-8972
  • Fax: 702-902-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number887502
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: