Provider Demographics
NPI:1417624230
Name:BANGAYAN, KAREN ARCENIO
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ARCENIO
Last Name:BANGAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 TAOS ESTATES ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8259
Mailing Address - Country:US
Mailing Address - Phone:702-466-3098
Mailing Address - Fax:
Practice Address - Street 1:1808 TAOS ESTATES ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8259
Practice Address - Country:US
Practice Address - Phone:702-466-3098
Practice Address - Fax:702-362-1732
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV843493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily