Home Professional Nurse Practitioner LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

HOME PROFESSIONAL NURSE PRACTITIONER LLC

Practice address

3017 W Charleston Blvd Ste 70
Las Vegas, NV 89102-1928

Phone

(702) 913-9380

NPI assigned

Dec 18, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Mae Derequito Lueck

Title

Ceo

Phone

(702) 913-9380

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1545091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1669944484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 W CHARLESTON BLVD STE 70",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021928",
            "telephone_number": "702-913-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 W CHARLESTON BLVD STE 70",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021928",
            "telephone_number": "702-913-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME PROFESSIONAL NURSE PRACTITIONER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-18",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "LUECK",
        "authorized_official_first_name": "MAE",
        "authorized_official_middle_name": "DEREQUITO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-913-9380",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Las Vegas, NV
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• Primary Care Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.