MEDICARE: DENISE ANN BRAVO RN, CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN78337	NV

General Provider Information

NPI Number	:	1003564188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ANN BRAVO RN, CCM

Provider Business Mailing Address
First Line	:	2917 GNATCATCHER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3120
Country	:	US
Telephone Number	:	702-217-8572
Fax Number	:	877-211-6856

Provider Business Practice Location Address
First Line	:	2917 GNATCATCHER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3120
Country	:	US
Telephone Number	:	702-217-8572
Fax Number	:	877-211-6856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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