MEDICARE: ARIUSKA MILAN MARTINEZ FNP-BC

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	101Y00000X	Counselor
2	363LF0000X	Family Nurse Practitioner	F12240377	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F12240377	OTHER	NV	CERTIFICATION #

General Provider Information

NPI Number	:	1336659903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIUSKA MILAN MARTINEZ FNP-BC

Provider Business Mailing Address
First Line	:	5305 CHAMPIONS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2902
Country	:	US
Telephone Number	:	702-510-9796
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2121
Country	:	US
Telephone Number	:	702-559-6509
Fax Number	:

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	01/05/2025

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