MEDICARE: B2 MEDICAL CONSULTING 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	:	1588411433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B2 MEDICAL CONSULTING LLC

Provider Business Mailing Address
First Line	:	11700 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12300 SANDY PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1116
Country	:	US
Telephone Number	:	702-606-2072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BEVERLY THIELKE
Credential	:	NP
Telephone Number	:	702-606-2072

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	05/01/2024

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