=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740256189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA LOIS BELLOW FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2006
-----------------------------------------------------
Last Update Date | 08/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6360 BOULDER HWY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89122-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-228-4520
-----------------------------------------------------
Fax | 877-889-5390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6360 BOULDER HWY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89122-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-228-4520
-----------------------------------------------------
Fax | 877-889-5390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 538632
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 002176
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------