MEDICARE: EBONI LATRICE ALGEE FNP-C

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	817019	NV

General Provider Information

NPI Number	:	1942865738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONI LATRICE ALGEE FNP-C

Provider Business Mailing Address
First Line	:	908 ERIC STOCKEN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4412
Country	:	US
Telephone Number	:	314-941-5989
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 ERIC STOCKEN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4412
Country	:	US
Telephone Number	:	314-941-5989
Fax Number	:

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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