Ivana P. Fukumoto, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN001217 Issued in NV

Practice address

2350 Corporate Cir Ste 201
Henderson, NV 89074-7737

Phone

(702) 562-8900

Fax

(702) 407-0266

NPI assigned

Sep 3, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ivanafukumoto@hcpnv.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279

  Pediatrics

  Medicare reassignment NPD
• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health Home Care

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD
• Healthcare Partners Medical Group (Coats) LTD.

  • Pediatrics Physician
  • Las Vegas, NV
  • NPI 1902883341
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1114234630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 CORPORATE CIR STE 201",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747737",
            "telephone_number": "702-562-8900",
            "fax_number": "702-407-0266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1799 Mount Mariah Dr",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891061501",
            "country_code": "US",
            "telephone_number": "800-787-2568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUKUMOTO",
        "first_name": "IVANA",
        "middle_name": "P.",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-03",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APN001217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "APRN001217",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114234630",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Fryer, RDN, LD
• Juian-Juian L Fu, M.D. & PH.D.
• Angela Fuentes
• Mariah Fuentes
• Iliana Esther Fuentez Osuna
• Full Function Physical Therapy, LLC
• Imani S Fuller
• Kaylee Arline Fuller
• Peter Fuller, M.D.
• Staci Fuller

• Family Nurse Practitioner in Henderson, NV
• Providers in Henderson, NV by specialty
• Family Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.