MEDICARE: TERESA MARIE HARTZ 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	APRN001190	NV

General Provider Information

NPI Number	:	1275542946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MARIE HARTZ APRN

Provider Business Mailing Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-657-1503
Fax Number	:	702-657-1583

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-657-1503
Fax Number	:	702-657-1583

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/02/2016

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