MEDICARE: DR. MYERANN ROYCE MANALOTO MANGALINO DNP,MSN,APRN,FNP-C

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	828092	NV
2	363L00000X	Nurse Practitioner	828092	NV

General Provider Information

NPI Number	:	1487283834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYERANN ROYCE MANALOTO MANGALINO DNP,MSN,APRN,FNP-C

Provider Business Mailing Address
First Line	:	657 N TOWN CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6332 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3234
Country	:	US
Telephone Number	:	702-227-1916
Fax Number	:

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	08/01/2024

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