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NPI Code Detail

MEDICARE: NIPAPORN TINA BUADAENG APRN

MEDICARE: NIPAPORN TINA BUADAENG 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
1363L00000XNurse PractitionerAPRN002918NV
2363LP0808XPsychiatric/Mental Health Nurse Practitioner2023191298NV

Other Identifiers

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

General Provider Information

NPI Number : 1366939019
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIPAPORN TINA BUADAENG APRN
Provider Business Mailing Address
First Line : 3425 CLIFF SHADOWS PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5111
Country : US
Telephone Number : 702-382-1599
Fax Number : 702-240-4962
Provider Business Practice Location Address
First Line : 3425 CLIFF SHADOWS PKWY STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5112
Country : US
Telephone Number : 702-382-1599
Fax Number : 702-240-4962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2018
Last Update Date : 05/27/2026

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Directions to “ NIPAPORN TINA BUADAENG APRN” Practice Location

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