MEDICARE: ADVANCED PRACTICE NURSING SPECIALISTS, LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1396137022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRACTICE NURSING SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	9205 W RUSSELL RD STE 305
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1446
Country	:	US
Telephone Number	:	917-628-8969
Fax Number	:	702-476-9233

Provider Business Practice Location Address
First Line	:	9205 W RUSSELL RD STE 305
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1446
Country	:	US
Telephone Number	:	917-628-8969
Fax Number	:	702-476-9233

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID J MEMMOLI
Credential	:	FNP-C
Telephone Number	:	917-628-8969

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	07/23/2024

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