Provider Demographics
NPI:1497868301
Name:MARRERO, RITA E (RN, CNM, PC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:E
Last Name:MARRERO
Suffix:
Gender:F
Credentials:RN, CNM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6448 PLUMCREST RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5331
Mailing Address - Country:US
Mailing Address - Phone:702-645-4262
Mailing Address - Fax:
Practice Address - Street 1:1815 E LAKE MEAD BLVD
Practice Address - Street 2:SUITE #317
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7187
Practice Address - Country:US
Practice Address - Phone:702-870-7386
Practice Address - Fax:702-870-3158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00054367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN06718OtherSTATE BOARD NURSING - RN
NVAPN00054OtherSTATE BOARD NURSING - APN
NVNM3718Medicare ID - Type Unspecified
NVS10865Medicare UPIN