Individual
MRS. IVANA P. FUKUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5575 S DURANGO DR STE 103, LAS VEGAS, NV 89113-1834
(702) 435-5437
(702) 851-9640
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN001217
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114234630
—
NV
Enumeration date
09/03/2010
Last updated
06/20/2025
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