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General NPI Number Information
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NPI Number | 1871306522
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Entity Type | Individual
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Provider Name | JACQUELLINE ASCENCIO
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Gender | Female
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3087 E WARM SPRINGS RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89120-3754
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Country | US
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Telephone | 702-463-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 EMERITUS CIR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-2217
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Country | US
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Telephone | 702-232-5734
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 886567
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License Number State | NV
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