MEDICARE: EDENLITA PANGILINAN ANTOLIN

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	887231	NV

General Provider Information

NPI Number	:	1609681659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDENLITA PANGILINAN ANTOLIN

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-877-5199
Fax Number	:

Provider Business Practice Location Address
First Line	:	4475 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7826
Country	:	US
Telephone Number	:	702-877-5199
Fax Number	:

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

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	12/08/2025

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Directions to “ EDENLITA PANGILINAN ANTOLIN ” Practice Location

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