MEDICARE: MR. SHAWN ADRIAN PILGRIM

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	163W00000X	Registered Nurse	NONE YET	NV

General Provider Information

NPI Number	:	1245675040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN ADRIAN PILGRIM

Provider Business Mailing Address
First Line	:	3144 MANTI PEAK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6550
Country	:	US
Telephone Number	:	702-430-0481
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 MANTI PEAK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6550
Country	:	US
Telephone Number	:	702-430-0481
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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