MEDICARE: MS. RENEE S EGBERT LPN

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	251J00000X	Nursing Care Agency	LPN15015	NV
2	164W00000X	Licensed Practical Nurse	LPN15015	NV

General Provider Information

NPI Number	:	1942709514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE S EGBERT LPN

Provider Business Mailing Address
First Line	:	4045 S BUFFALO DR STE A101-241
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7479
Country	:	US
Telephone Number	:	702-927-3612
Fax Number	:

Provider Business Practice Location Address
First Line	:	8501 W UNIVERSITY AVE # 24-2095
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6157
Country	:	US
Telephone Number	:	702-927-3612
Fax Number	:

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	02/08/2018

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