Provider Demographics
NPI:1689230500
Name:JUSTO, EILEEN PABLO (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:PABLO
Last Name:JUSTO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10239 MONTES VASCOS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8450
Mailing Address - Country:US
Mailing Address - Phone:808-375-6097
Mailing Address - Fax:
Practice Address - Street 1:6276 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3242
Practice Address - Country:US
Practice Address - Phone:702-220-5557
Practice Address - Fax:702-220-5565
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818049363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care