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General NPI Number Information
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NPI Number | 1023725363
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Entity Type | Individual
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Provider Name | REYSEL CHAVEZ MEDINA MSN-APRN-FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 4415 HAWTHORNE WAY
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City | LAS VEGAS
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State | NV
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Zip | 89147-4605
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Country | US
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Telephone | 702-722-3314
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Fax | 702-722-3752
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Provider Business Mailing Address
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Address Line | 9804 CORNWALL CROSSING LN
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City | LAS VEGAS
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State | NV
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Zip | 89147-7706
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Country | US
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Telephone | 702-772-7705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11022837
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 818580
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License Number State | NV
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