MEDICARE: DR. ESTRELLA P EVANGELISTA DNP, MED, PMHNP-BC

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	171400000X	Health & Wellness Coach		NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	852512	NV

General Provider Information

NPI Number	:	1114445756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTRELLA P EVANGELISTA DNP, MED, PMHNP-BC

Provider Business Mailing Address
First Line	:	6605 GRAND MONTECITO PKWY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	702-401-8794
Fax Number	:

Provider Business Practice Location Address
First Line	:	6605 GRAND MONTECITO PKWY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	702-401-8794
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	08/23/2023

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