MEDICARE: MR. CURTIS D CHILD APRN, FNP

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	363L00000X	Nurse Practitioner	1985124405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70569	OTHER	UT	PEHP

General Provider Information

NPI Number	:	1144327099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS D CHILD APRN, FNP

Provider Business Mailing Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:	110
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-227-4165
Fax Number	:	702-227-7921

Provider Business Practice Location Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:	110
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-227-4165
Fax Number	:	702-227-7921

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/08/2007

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