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NPI Code Detail

MEDICARE: ANDREW JOHN MISTRETTA LPN

MEDICARE: ANDREW JOHN MISTRETTA LPN
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
1164W00000XLicensed Practical Nurse856950NV

General Provider Information

NPI Number : 1053180281
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JOHN MISTRETTA LPN
Provider Business Mailing Address
First Line : 3050 S NELLIS BLVD APT 1052
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7763
Country : US
Telephone Number : 951-515-3049
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0810
Country : US
Telephone Number : 702-463-0300
Fax Number : 702-463-0301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2023
Last Update Date : 12/28/2023

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