Provider Demographics
NPI:1598522419
Name:BELPORT, MARY S (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:BELPORT
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 1:5070 TARA AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5464
Mailing Address - Country:US
Mailing Address - Phone:702-494-8116
Mailing Address - Fax:
Practice Address - Street 1:6045 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5565
Practice Address - Country:US
Practice Address - Phone:702-948-5095
Practice Address - Fax:702-948-5115
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVRN24102163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse