MEDICARE: CONNIE N DOUGLASS FNP

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	893727	NV

General Provider Information

NPI Number	:	1255069688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE N DOUGLASS FNP

Provider Business Mailing Address
First Line	:	1371 W WARM SPRINGS RD STE 120
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-8068
Country	:	US
Telephone Number	:	702-213-3099
Fax Number	:	888-498-3867

Provider Business Practice Location Address
First Line	:	1371 W WARM SPRINGS RD STE 120
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-8068
Country	:	US
Telephone Number	:	702-213-3099
Fax Number	:	888-498-3867

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	06/19/2026

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