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General NPI Number Information
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NPI Number | 1841922234
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Entity Type | Individual
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Provider Name | REBA MARYANN MATHEW APRN
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Gender | Female
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Dates
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Enumeration Date | 06/26/2022
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Last Update Date | 06/26/2022
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Provider Practice Location Address
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Address Line | 4218 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-1625
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Country | US
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Telephone | 702-425-5050
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Fax | 702-243-0117
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Provider Business Mailing Address
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Address Line | 10241 ANGELS LOFT ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-1541
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Country | US
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Telephone | 702-430-0424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 854662
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License Number State | NV
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