Provider Demographics
NPI:1407539307
Name:TADEO, ARNOLD BRYAN PALMA (RN)
Entity Type:Individual
Prefix:
First Name:ARNOLD BRYAN
Middle Name:PALMA
Last Name:TADEO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2029
Mailing Address - Country:US
Mailing Address - Phone:858-225-9373
Mailing Address - Fax:
Practice Address - Street 1:2055 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2029
Practice Address - Country:US
Practice Address - Phone:858-225-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95288415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse