Provider Demographics
NPI:1003564188
Name:BRAVO, DENISE ANN (RN, CCM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:BRAVO
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 GNATCATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3120
Mailing Address - Country:US
Mailing Address - Phone:702-217-8572
Mailing Address - Fax:877-211-6856
Practice Address - Street 1:2917 GNATCATCHER AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3120
Practice Address - Country:US
Practice Address - Phone:702-217-8572
Practice Address - Fax:877-211-6856
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN78337163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management