=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750909453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAN MICHAEL ARCEO DNP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2020
-----------------------------------------------------
Last Update Date | 10/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3140 S RAINBOW BLVD STE 401
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-6234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-476-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3140 S RAINBOW BLVD STE 401
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-6234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-476-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAN MICHAEL ARCEO
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 702-476-4321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------