Individual provider Active NPI

Marie Jo Borres

  • Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1336698091
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
812661 Issued in NV
Practice address
4324 S Eastern Ave Ste B
Las Vegas, NV 89119-6064
Phone
(702) 743-7314
NPI assigned
Sep 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 6228389-4409 UT
Nurse Practitioner 363L00000X 812661 NV Primary

Addresses

Primary practice location

4324 S Eastern Ave Ste B
Las Vegas, NV 89119-6064

Mailing address

4324 S Eastern Ave Ste B
Las Vegas, NV 89119-6064
Phone (702) 743-7314

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240618003867 NV Practitioner - Nurse Practitioner 5294022869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2105 Port Ave
Las Vegas, NV 89106-1798
Phone (702) 743-7314

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
812661NVMDNurse Practitioner
6228389-4409UTMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maat Wellness Centeer Gerontology CurrentSince Feb 25, 2024 Accepting new patients

Locations

4324 S Eastern Ave
Ste B
Las Vegas, NV 89119
Phone (702) 405-8500

Organizations & group practices 1

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1336698091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4324 S EASTERN AVE STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196064",
            "telephone_number": "702-743-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4324 S EASTERN AVE STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196064",
            "telephone_number": "702-743-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORRES",
        "first_name": "MARIE JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-22",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "UT",
            "license": "6228389-4409",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "812661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.