Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN001551 | NV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN001551 | NV |
NPI | 1003249368 |
---|---|
Provider Name | Ms. Lotis Gay Perilla Edano |
First Address | Las Vegas, NV 89169-1778 |
Second Address | Las Vegas, NV 89169-1778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2013 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003249368 | (05) | NV |
836163 | (05) | AZ |