MEDICARE: ATONGANE TAKU 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	826043	NV

General Provider Information

NPI Number	:	1184364747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATONGANE TAKU APRN

Provider Business Mailing Address
First Line	:	10956 ROYAL HIGHLANDS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10956 ROYAL HIGHLANDS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4364
Country	:	US
Telephone Number	:	240-706-6920
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	03/31/2022

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