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NPI Code Detail

MEDICARE: MADELINE TEPPERBERG STUDENT CNM

MEDICARE: MADELINE TEPPERBERG STUDENT CNM
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
1163WX0003XInpatient Obstetric Registered NurseRN289874GA

General Provider Information

NPI Number : 1821957044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE TEPPERBERG STUDENT CNM
Provider Business Mailing Address
First Line : 453 VIGO PORT ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-1603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 229-506-2847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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