=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659892123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONERS STAFFING CORP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5693 S JONES BLVD STE 102
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89118-1969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-856-4414
-----------------------------------------------------
Fax | 855-641-8906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5693 S JONES BLVD STE 102
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89118-1969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-856-4414
-----------------------------------------------------
Fax | 855-641-8906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | RONNIE M VALLE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 714-856-4414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2406
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------