Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 00232 | NV |
NPI | 1093916603 |
---|---|
Provider Name | Mrs. Evelyn Dela Rea Vazquez |
First Address | Las Vegas, NV 89117-5918 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |