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NPI Code Detail

MEDICARE: TENDAI GOMBE-LANE RN

MEDICARE: TENDAI GOMBE-LANE RN
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
1163WH0200XHome Health Registered Nurse81777NV

General Provider Information

NPI Number : 1003683897
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENDAI GOMBE-LANE RN
Provider Business Mailing Address
First Line : 4423 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4423 W FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3703
Country : US
Telephone Number : 702-458-1137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2023
Last Update Date : 12/11/2023

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Directions to “ TENDAI GOMBE-LANE RN” Practice Location

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