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General NPI Number Information
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NPI Number | 1740013184
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Entity Type | Organization
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Legal Business Name | BATTLEBORN GERIATRICS PLLC
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 1073 DORTMUNDER DR
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City | SPARKS
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State | NV
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Zip | 89441-5848
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Country | US
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Telephone | 775-303-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 DORTMUNDER DR
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City | SPARKS
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State | NV
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Zip | 89441-5848
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Country | US
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Telephone | 775-303-2377
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Fax |
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Authorized Official
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Title or Position | APRN/OWNER
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Name | BLAKE KREK
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Credential | AG-ANCP-BC
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Telephone | 775-303-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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