Provider Demographics
NPI:1164987871
Name:BRENDA PRIMERO NP LLC
Entity Type:Organization
Organization Name:BRENDA PRIMERO NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMERO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:702-882-5561
Mailing Address - Street 1:8125 NOTTINGHAM HILL LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1888
Mailing Address - Country:US
Mailing Address - Phone:702-882-5561
Mailing Address - Fax:
Practice Address - Street 1:8125 NOTTINGHAM HILL LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1888
Practice Address - Country:US
Practice Address - Phone:702-882-5561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1831613025Medicaid