Organization
SHORELINES
Active
Other names
Shorelines
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEREDITH D'AGOSTINO NP (PRACTICE OWNER)
(843) 619-3571
Entity
Organization
Contact information
Practice address
500 N RAINBOW BLVD, LAS VEGAS, NV 89107-1082
(843) 619-3571
Mailing address
500 N RAINBOW BLVD STE 300-345, LAS VEGAS, NV 89107-1082
(833) 246-8353
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871752303
—
SC
01
—
816203
NV - APRN LICENSE
NV
Enumeration date
12/02/2019
Last updated
09/08/2020
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