MEDICARE: ROSEMARIE SALACUP LIZARDO FNP-C

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	208VP0014X	Interventional Pain Medicine Physician	825338	NV
2	363LF0000X	Family Nurse Practitioner	825338	NV
3	363L00000X	Nurse Practitioner	825338	NV

General Provider Information

NPI Number	:	1083251250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE SALACUP LIZARDO FNP-C

Provider Business Mailing Address
First Line	:	700 E SILVERADO RANCH BLVD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7518
Country	:	US
Telephone Number	:	702-240-6482
Fax Number	:	702-804-0957

Provider Business Practice Location Address
First Line	:	2839 SAINT ROSE PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4848
Country	:	US
Telephone Number	:	702-240-6482
Fax Number	:	702-240-8529

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	05/02/2021

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