MEDICARE: NCD CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	363L00000X	Nurse Practitioner	NV
2	363LF0000X	Family Nurse Practitioner	NV
3	363LP2300X	Primary Care Nurse Practitioner	NV

General Provider Information

NPI Number	:	1386185049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NCD CONSULTING LLC

Provider Business Mailing Address
First Line	:	871 CORONADO CENTER DR
Second Line	:	SUITE 200
City	:	HENDERSON
State	:	NV
Zip	:	89052-3977
Country	:	US
Telephone Number	:	702-202-7869
Fax Number	:	702-680-4163

Provider Business Practice Location Address
First Line	:	871 CORONADO CENTER DR
Second Line	:	SUITE 200
City	:	HENDERSON
State	:	NV
Zip	:	89052-3977
Country	:	US
Telephone Number	:	702-202-7869
Fax Number	:	702-680-4163

Authorized Official
Title or Position	:	CEO
Name	:	NERISSA C DIMAILIG
Credential	:	APRN
Telephone Number	:	702-202-7869

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/16/2017

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Directions to “NCD CONSULTING LLC ” Practice Location

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