MEDICARE: RIN PROMTHED BOONJUE 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	163WM1400X	Nurse Massage Therapist (NMT)	893764	NV

General Provider Information

NPI Number	:	1548130172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIN PROMTHED BOONJUE RN

Provider Business Mailing Address
First Line	:	3817 PEACHGATE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2633
Country	:	US
Telephone Number	:	725-287-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3817 PEACHGATE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2633
Country	:	US
Telephone Number	:	725-287-5720
Fax Number	:

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

Provider Enumeration Date	:	11/08/2025
Last Update Date	:	11/08/2025

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Directions to “ RIN PROMTHED BOONJUE RN” Practice Location

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