=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982332227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA JILL BUENA ALFONSO APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2022
-----------------------------------------------------
Last Update Date | 08/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 KAREN AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89169-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-625-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3044 OCEAN PORT DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-0210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-612-8711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | RN56862
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------