MEDICARE: MARIA LORENA CORNEJO 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	163W00000X	Registered Nurse	81407	NV

General Provider Information

NPI Number	:	1386457463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LORENA CORNEJO RN

Provider Business Mailing Address
First Line	:	3683 VIA AMIGOS PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-3714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3683 VIA AMIGOS PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-3714
Country	:	US
Telephone Number	:	510-332-9890
Fax Number	:

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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