Provider Demographics
NPI:1518533496
Name:RABAGO-AQUINO, KAREN AILEEN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:AILEEN
Last Name:RABAGO-AQUINO
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 1:7721 WILD CREST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1930
Mailing Address - Country:US
Mailing Address - Phone:702-355-7547
Mailing Address - Fax:
Practice Address - Street 1:7721 WILD CREST ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1930
Practice Address - Country:US
Practice Address - Phone:702-355-7547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner