MEDICARE: MR. AUDRIE LAINIER PURA CRUZ 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	832149	NV

General Provider Information

NPI Number	:	1972453108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUDRIE LAINIER PURA CRUZ APRN

Provider Business Mailing Address
First Line	:	4270 S DECATUR BLVD STE B6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6802
Country	:	US
Telephone Number	:	702-485-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE B6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6802
Country	:	US
Telephone Number	:	702-485-2100
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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