MEDICARE: WENDEL HANNAH BORJAL

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	163WG0000X	General Practice Registered Nurse	833948	NV

General Provider Information

NPI Number	:	1588531008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDEL HANNAH BORJAL

Provider Business Mailing Address
First Line	:	1408 LUCILEE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-1614
Country	:	US
Telephone Number	:	702-609-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 LUCILEE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-1614
Country	:	US
Telephone Number	:	702-609-0955
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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