Provider Demographics
NPI:1316546583
Name:RENTERIA, ANA (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MARYLAND PKWY STE 64
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3005
Mailing Address - Country:US
Mailing Address - Phone:702-735-7900
Mailing Address - Fax:
Practice Address - Street 1:3661 S MARYLAND PKWY STE 64
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3005
Practice Address - Country:US
Practice Address - Phone:702-735-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN13289164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1174064786Medicaid