MEDICARE: MS. MARVI LAPUZ REYES FNP

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	AP8437	AZ
2	363LF0000X	Family Nurse Practitioner	811418	NV

General Provider Information

NPI Number	:	1760840565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARVI LAPUZ REYES FNP

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	10105 BANBURRY CROSS DR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6647
Country	:	US
Telephone Number	:	702-877-5199
Fax Number	:

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

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	04/19/2023

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