MEDICARE: MISEL REYES DIAZ APRN

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	814317	NV

General Provider Information

NPI Number	:	1841873106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISEL REYES DIAZ APRN

Provider Business Mailing Address
First Line	:	5585 BIRCHWOOD CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1941
Country	:	US
Telephone Number	:	702-589-1912
Fax Number	:

Provider Business Practice Location Address
First Line	:	4275 S BURNHAM ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5400
Country	:	US
Telephone Number	:	702-384-7669
Fax Number	:	702-385-7669

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

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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Directions to “ MISEL REYES DIAZ APRN” Practice Location

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