| NPI | 1639975089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENZO TAN OMANDAC Nurse Practitioner 702-569-2352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-03-01 |