MEDICARE: JON A FAILLA APRN PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN002252	NV
2	363LF0000X	Family Nurse Practitioner	APRN002252	NV

General Provider Information

NPI Number	:	1780110247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JON A FAILLA APRN PLLC

Provider Business Mailing Address
First Line	:	182 APACHE TEAR CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2996
Country	:	US
Telephone Number	:	702-443-8816
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 APACHE TEAR CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2996
Country	:	US
Telephone Number	:	702-443-8816
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JON A FAILLA
Credential	:	APRN
Telephone Number	:	702-443-8816

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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