MEDICARE: JOANA SOTELO NP

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	163WE0003X	Emergency Registered Nurse	RN72350	NV
2	363L00000X	Nurse Practitioner	858725	NV

General Provider Information

NPI Number	:	1184358830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANA SOTELO NP

Provider Business Mailing Address
First Line	:	6530 OZZIE HARRIET AVE UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-1722
Country	:	US
Telephone Number	:	702-501-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	6530 OZZIE HARRIET AVE UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-1722
Country	:	US
Telephone Number	:	702-501-3099
Fax Number	:

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

Provider Enumeration Date	:	07/10/2022
Last Update Date	:	09/26/2022

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