MEDICARE: MARK JANSENE MANIAGO FNP-BC

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	817084	NV

General Provider Information

NPI Number	:	1861277113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JANSENE MANIAGO FNP-BC

Provider Business Mailing Address
First Line	:	7777 S JONES BLVD APT 1053
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6152
Country	:	US
Telephone Number	:	702-278-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 S JONES BLVD APT 1053
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6152
Country	:	US
Telephone Number	:	702-278-3295
Fax Number	:

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	10/05/2023

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