MEDICARE: JAQUIN LARINE FIELDER LPN

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	164W00000X	Licensed Practical Nurse	LPN17257	NV

General Provider Information

NPI Number	:	1609404623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUIN LARINE FIELDER LPN

Provider Business Mailing Address
First Line	:	1861 PEAR HATPIN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-980-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6849 W CHARLESTON BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1649
Country	:	US
Telephone Number	:	702-980-2544
Fax Number	:

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

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	03/27/2020

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