Provider Demographics
NPI:1710404793
Name:QUINESARES, CHARYNNE A (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARYNNE
Middle Name:A
Last Name:QUINESARES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9077 S PECOS RD STE 3800
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7182
Practice Address - Country:US
Practice Address - Phone:702-947-1940
Practice Address - Fax:702-947-1966
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002568363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710404793Medicaid
NVPENDINGMedicaid
NVAPRN002568OtherSTATE LICENSE