MEDICARE: ZELLUYAH W GAITHO APN

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	163W00000X	Registered Nurse	RN44601	NV
2	363L00000X	Nurse Practitioner	APN001242	NV
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN001242	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V109126	OTHER	NV	SMA MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1659672939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZELLUYAH W GAITHO APN

Provider Business Mailing Address
First Line	:	4270 S DECATUR BLVD STE B6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6802
Country	:	US
Telephone Number	:	702-485-2100
Fax Number	:	702-825-0091

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE B6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6802
Country	:	US
Telephone Number	:	702-485-2100
Fax Number	:	702-825-0091

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	03/22/2021

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Directions to “ ZELLUYAH W GAITHO APN” Practice Location

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