MEDICARE: CRESCENT HEALTH 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1417573148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT HEALTH LLC

Provider Business Mailing Address
First Line	:	6480 CREST ESTATES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3253
Country	:	US
Telephone Number	:	702-528-2195
Fax Number	:	702-778-8026

Provider Business Practice Location Address
First Line	:	6480 CREST ESTATES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3253
Country	:	US
Telephone Number	:	702-528-2195
Fax Number	:	702-778-8026

Authorized Official
Title or Position	:	CEO/FNP
Name	:	MRS. MAGDALENA RODRIGUEZ
Credential	:	APRN, FNP-C
Telephone Number	:	702-608-3574

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	06/18/2020

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