MEDICARE: GENEA WRAGG

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	APRN11003626	FL
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	841199	NV
3	363LF0000X	Family Nurse Practitioner	841199	NV

General Provider Information

NPI Number	:	1588296156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEA WRAGG

Provider Business Mailing Address
First Line	:	5443 TARTAN HILL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9970 W CHEYENNE AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7700
Country	:	US
Telephone Number	:	702-978-8900
Fax Number	:

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/02/2024

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Directions to “ GENEA WRAGG ” Practice Location

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