MEDICARE: NURSEDX OF NEVADA 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1114577152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSEDX OF NEVADA LLC

Provider Business Mailing Address
First Line	:	6392 MCLEOD DR STE 9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4417
Country	:	US
Telephone Number	:	949-395-6883
Fax Number	:	866-246-3093

Provider Business Practice Location Address
First Line	:	6392 MCLEOD DR STE 9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4417
Country	:	US
Telephone Number	:	949-395-6883
Fax Number	:	866-246-3093

Authorized Official
Title or Position	:	OWNER
Name	:	ARLENE GAYARES
Credential	:	RN
Telephone Number	:	949-395-6883

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	11/18/2021

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