MEDICARE: KAREN AILEEN RABAGO-AQUINO

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	842082	NV

General Provider Information

NPI Number	:	1518533496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN AILEEN RABAGO-AQUINO

Provider Business Mailing Address
First Line	:	7721 WILD CREST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1930
Country	:	US
Telephone Number	:	702-355-7547
Fax Number	:

Provider Business Practice Location Address
First Line	:	7721 WILD CREST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1930
Country	:	US
Telephone Number	:	702-355-7547
Fax Number	:

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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