MEDICARE: IRENE NANAO INES APRN-CNP

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	363LP2300X	Primary Care Nurse Practitioner	821332	NV

General Provider Information

NPI Number	:	1962225516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE NANAO INES APRN-CNP

Provider Business Mailing Address
First Line	:	990 MOSSY VALE ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4583
Country	:	US
Telephone Number	:	586-565-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 S MARYLAND PKWY STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2423
Country	:	US
Telephone Number	:	702-910-6857
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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