MEDICARE: MARIAFE MANALANG VITAL APRN, FNP-C

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	APRN001475	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629314786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAFE MANALANG VITAL APRN, FNP-C

Provider Business Mailing Address
First Line	:	8936 SPANISH RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1354
Country	:	US
Telephone Number	:	702-998-2816
Fax Number	:	702-998-2991

Provider Business Practice Location Address
First Line	:	400 SHADOW LN
Second Line	:	STE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4363
Country	:	US
Telephone Number	:	702-731-0909
Fax Number	:	702-826-4757

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

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	10/08/2019

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Directions to “ MARIAFE MANALANG VITAL APRN, FNP-C” Practice Location

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