MEDICARE: BRENDA PRIMERO NP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164987871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA PRIMERO NP LLC

Provider Business Mailing Address
First Line	:	5155 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7695
Country	:	US
Telephone Number	:	702-882-5561
Fax Number	:	702-956-9016

Provider Business Practice Location Address
First Line	:	5155 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7695
Country	:	US
Telephone Number	:	702-882-5561
Fax Number	:	702-956-9016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BRENDA PRIMERO
Credential	:	APRN, NP-C, PMHNP-BC
Telephone Number	:	702-882-5561

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	07/18/2025

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