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NPI Code Detail

MEDICARE: MARIE JO BORRES

MEDICARE: MARIE JO BORRES
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
1363LG0600XGerontology Nurse Practitioner6228389-4409UT
2363L00000XNurse Practitioner812661NV

General Provider Information

NPI Number : 1336698091
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE JO BORRES
Provider Business Mailing Address
First Line : 4324 S EASTERN AVE STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6064
Country : US
Telephone Number : 702-743-7314
Fax Number :
Provider Business Practice Location Address
First Line : 4324 S EASTERN AVE STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-6064
Country : US
Telephone Number : 702-743-7314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2016
Last Update Date : 03/28/2025

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Directions to “ MARIE JO BORRES ” Practice Location

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