MEDICARE: CHRIS ELAINE L MARIANO 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	RN44936	NV
2	363LP0222X	Critical Care Pediatric Nurse Practitioner	TAPN700431	NV
3	363LP0200X	Pediatric Nurse Practitioner	APN1054	NV

General Provider Information

NPI Number	:	1780830828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS ELAINE L MARIANO APN

Provider Business Mailing Address
First Line	:	280 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2936
Country	:	US
Telephone Number	:	702-759-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1972 NAPOLEON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156
Country	:	US
Telephone Number	:	702-217-7470
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	10/24/2019

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