MEDICARE: MS. BEVERLY BATALLA THIELKE APRN

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	363L00000X	Nurse Practitioner	837645	NV
2	363LF0000X	Family Nurse Practitioner	837645	NV
3	363LA2100X	Acute Care Nurse Practitioner	837645	NV

General Provider Information

NPI Number	:	1043801012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY BATALLA THIELKE APRN

Provider Business Mailing Address
First Line	:	3459 SAINT ROSE PKWY STE 120-481
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4601
Country	:	US
Telephone Number	:	702-781-4800
Fax Number	:	702-664-6755

Provider Business Practice Location Address
First Line	:	12300 SANDY PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1116
Country	:	US
Telephone Number	:	702-606-2072
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	10/22/2024

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