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General NPI Number Information
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NPI Number | 1013612092
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Entity Type | Organization
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Legal Business Name | PRIME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 01/27/2024
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Provider Practice Location Address
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Address Line | 5052 S JONES BLVD STE 130
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City | LAS VEGAS
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State | NV
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Zip | 89118-0567
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Country | US
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Telephone | 702-466-4148
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Fax | 702-904-8704
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Provider Business Mailing Address
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Address Line | 6999 BARD AVE
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City | LAS VEGAS
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State | NV
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Zip | 89113-5537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MARIE ANN PO
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Credential |
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Telephone | 702-466-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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