Provider Demographics
NPI:1114297603
Name:TAKU, RELINDIS (NP)
Entity Type:Individual
Prefix:
First Name:RELINDIS
Middle Name:
Last Name:TAKU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 S EASTERN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2545
Mailing Address - Country:US
Mailing Address - Phone:702-403-4770
Mailing Address - Fax:702-446-8122
Practice Address - Street 1:8275 S EASTERN AVE SUITE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2545
Practice Address - Country:US
Practice Address - Phone:702-403-4770
Practice Address - Fax:702-446-8122
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816830363LA2100X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health