MEDICARE: DEPARTMENT OF VETERANS AFFAIRS

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	286500000X	Military Hospital	RN 22304	NV

General Provider Information

NPI Number	:	1093981672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	164 WELLSPRING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7616
Country	:	US
Telephone Number	:	702-653-3172
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 NORTH LAS VEGAS BLVD.
Second Line	:	NELLIS AIR FORCE BASE
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-6601
Country	:	US
Telephone Number	:	702-653-3172
Fax Number	:

Authorized Official
Title or Position	:	NURSE CLINICAL COORDINATOR
Name	:	MRS. MARIETTA A. CABILLO
Credential	:	MSN, RN, BC
Telephone Number	:	702-653-3172

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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Directions to “DEPARTMENT OF VETERANS AFFAIRS ” Practice Location

Language	Start Address	Practice Location

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