Organization
HOME PROFESSIONAL NURSE PRACTITIONER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAE DEREQUITO LUECK (CEO)
(702) 913-9380
Entity
Organization
Contact information
Practice address
3017 W CHARLESTON BLVD STE 70, LAS VEGAS, NV 89102-1928
(702) 913-9380
Mailing address
3017 W CHARLESTON BLVD STE 70, LAS VEGAS, NV 89102-1928
(702) 913-9380
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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