MEDICARE: CYNTHIA RAE HOUTROUW 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	363L00000X	Nurse Practitioner	APRN002246	NV
2	363LF0000X	Family Nurse Practitioner	APRN002246	NV

General Provider Information

NPI Number	:	1952753626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA RAE HOUTROUW APRN

Provider Business Mailing Address
First Line	:	9420 STEELTREE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1145
Country	:	US
Telephone Number	:	702-277-1357
Fax Number	:	833-457-5317

Provider Business Practice Location Address
First Line	:	330 S LOLA LN
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-0878
Country	:	US
Telephone Number	:	702-277-1135
Fax Number	:	833-457-5317

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

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	03/25/2021

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