Provider Demographics
NPI:1124593173
Name:BUCO, TERESA PATAWARAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:PATAWARAN
Last Name:BUCO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 AMERICAN PACIFIC DR APT 7207
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7613
Mailing Address - Country:US
Mailing Address - Phone:702-587-5833
Mailing Address - Fax:
Practice Address - Street 1:801 S RANCHO DR STE E7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3812
Practice Address - Country:US
Practice Address - Phone:702-478-5133
Practice Address - Fax:702-478-5401
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95165109163W00000X
NV811511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95165109OtherCALIFORNIA BOARD OF NURSING
NV811511OtherNEVADA BOARD OF NURSING