Provider Demographics
NPI:1356309165
Name:TOWNES, SOCORRO CABATO (APRN)
Entity Type:Individual
Prefix:
First Name:SOCORRO
Middle Name:CABATO
Last Name:TOWNES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SOCORRO
Other - Middle Name:A
Other - Last Name:CABATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-877-5199
Mailing Address - Fax:
Practice Address - Street 1:4475 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-877-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002921363L00000X
VA0024164639363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356309165Medicaid
VA017440R53Medicare PIN
VA1356309165Medicaid
VAP96873Medicare UPIN