=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245758341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE FEDERICO PALACIOS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10624 S EASTERN AVE
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-2982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-551-9085
-----------------------------------------------------
Fax | 702-407-7016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11148 ROBIN PARK AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89138-7598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-545-7007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN002589
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------