MEDICARE: MARY E CARNEY RN

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	163W00000X	Registered Nurse	RN28717	NV

General Provider Information

NPI Number	:	1093044885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E CARNEY RN

Provider Business Mailing Address
First Line	:	3949 W ALEXANDER RD
Second Line	:	APT 1284
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2906
Country	:	US
Telephone Number	:	702-646-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WAYNE NEWTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89111-5000
Country	:	US
Telephone Number	:	702-000-0000
Fax Number	:

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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