MEDICARE: ANA RENTERIA LICENSED PRACTICAL N

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	164W00000X	Licensed Practical Nurse	LPN13289	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316546583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA RENTERIA LICENSED PRACTICAL N

Provider Business Mailing Address
First Line	:	3661 S MARYLAND PKWY STE 64
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3005
Country	:	US
Telephone Number	:	702-735-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 S MARYLAND PKWY STE 64
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3005
Country	:	US
Telephone Number	:	702-735-7900
Fax Number	:

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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Directions to “ ANA RENTERIA LICENSED PRACTICAL N” Practice Location

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