MEDICARE: GARRETT CAMERON RN

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	163WG0000X	General Practice Registered Nurse	819542	NV

General Provider Information

NPI Number	:	1336829290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT CAMERON RN

Provider Business Mailing Address
First Line	:	6948 STURGEON CAPE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1522
Country	:	US
Telephone Number	:	928-925-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	11750 SUMMIT CLUB DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-7941
Country	:	US
Telephone Number	:	928-925-2440
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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