Provider Demographics
NPI:1568634335
Name:BASILIO, ELEANOR C (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:C
Last Name:BASILIO
Suffix:
Gender:F
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:PO BOX 360001
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036-8108
Mailing Address - Country:US
Mailing Address - Phone:702-653-3637
Mailing Address - Fax:702-653-2131
Practice Address - Street 1:4700 LAS VEGAS BLVD.
Practice Address - Street 2:
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-653-3637
Practice Address - Fax:702-653-2131
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 253893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse