MEDICARE: MARIA L BURGESS APRN

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	363LF0000X	Family Nurse Practitioner	APRN001574	NV

General Provider Information

NPI Number	:	1164857488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA L BURGESS APRN

Provider Business Mailing Address
First Line	:	5875 S RAINBOW BLVD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2556
Country	:	US
Telephone Number	:	702-465-7471
Fax Number	:	949-404-6317

Provider Business Practice Location Address
First Line	:	5875 S RAINBOW BLVD
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2556
Country	:	US
Telephone Number	:	702-465-7471
Fax Number	:	949-404-6317

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

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	04/25/2023

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