MEDICARE: ULTIMATE CHOICE LLC

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	APN001229	NV

General Provider Information

NPI Number	:	1063722122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE CHOICE LLC

Provider Business Mailing Address
First Line	:	5440 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0355
Country	:	US
Telephone Number	:	702-256-3637
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NANCI A QUINN
Credential	:	APN
Telephone Number	:	702-256-3637

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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