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NPI Code Detail

MEDICARE: MMCS LLC KATHRYN GELO SOLE MBR

MEDICARE: MMCS LLC KATHRYN GELO SOLE MBR
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
1363LF0000XFamily Nurse PractitionerAPN00362NV

General Provider Information

NPI Number : 1265681589
Entity Type Code : Organization
Provider Name (Legal Business Name) : MMCS LLC KATHRYN GELO SOLE MBR
Provider Business Mailing Address
First Line : PO BOX 34171
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-4171
Country : US
Telephone Number : 702-497-9706
Fax Number : 702-965-2544
Provider Business Practice Location Address
First Line : 10401 CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1151
Country : US
Telephone Number : 702-497-9706
Fax Number : 702-965-2544
Authorized Official
Title or Position : OWNER
Name : KATHRYN GELO
Credential : APN
Telephone Number : 702-497-9706
Provider Enumeration Date : 09/10/2008
Last Update Date : 05/28/2009

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