MEDICARE: BEATRICE MARY BLAY FNP

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	363LF0000X	Family Nurse Practitioner	APRN002707	NV

General Provider Information

NPI Number	:	1053830430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE MARY BLAY FNP

Provider Business Mailing Address
First Line	:	350 FALCON RIDGE PKWY STE 102
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8879
Country	:	US
Telephone Number	:	702-345-3312
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 FALCON RIDGE PKWY STE 102
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8879
Country	:	US
Telephone Number	:	678-791-5343
Fax Number	:	702-345-3374

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

Provider Enumeration Date	:	09/17/2017
Last Update Date	:	08/12/2022

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