Individual
IDA PRAILE SORONGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3343 S EASTERM AVENUE, LAS VEGAS, NV 89169
(702) 731-0909
(702) 731-1020
Mailing address
8936 SPANISH RIDGE AVE, LAS VEGAS, NV 89148-1354
(702) 998-2816
(702) 998-2991
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN001519
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700225844
—
NV
Enumeration date
06/21/2013
Last updated
10/09/2019
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