MEDICARE: BRENYSHA LASHA ROSE

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	171M00000X	Case Manager/Care Coordinator		NV

General Provider Information

NPI Number	:	1215865910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENYSHA LASHA ROSE

Provider Business Mailing Address
First Line	:	4754 TREE SWING AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4502
Country	:	US
Telephone Number	:	702-701-5359
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 W OWENS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6865
Country	:	US
Telephone Number	:	702-701-5359
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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