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NPI Code Detail

MEDICARE: ANTONETTE VERGARA APRN

MEDICARE: ANTONETTE VERGARA 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 PractitionerAPRN002468NV
2163WP0000XPain Management Registered NurseAPRN002468NV

General Provider Information

NPI Number : 1376083394
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONETTE VERGARA APRN
Provider Business Mailing Address
First Line : 2809 W CHARLESTON BLVD # 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1998
Country : US
Telephone Number : 702-476-9999
Fax Number :
Provider Business Practice Location Address
First Line : 1569 E FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5321
Country : US
Telephone Number : 702-476-9999
Fax Number : 702-946-1343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2017
Last Update Date : 08/05/2019

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