Provider Demographics
NPI:1760828214
Name:OCTAVIANO, ROSANNA R (APN)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:R
Last Name:OCTAVIANO
Suffix:
Gender:F
Credentials:APN
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 778207
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8207
Mailing Address - Country:US
Mailing Address - Phone:702-855-0748
Mailing Address - Fax:702-436-8088
Practice Address - Street 1:3680 E SUNSET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7235
Practice Address - Country:US
Practice Address - Phone:702-855-0748
Practice Address - Fax:702-436-8088
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001140364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPN001140OtherNURSING LICENSE