Provider Demographics
NPI:1942709514
Name:EGBERT, RENEE S (LPN)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:S
Last Name:EGBERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 S BUFFALO DR STE A101-241
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7479
Mailing Address - Country:US
Mailing Address - Phone:702-927-3612
Mailing Address - Fax:
Practice Address - Street 1:8501 W UNIVERSITY AVE # 24-2095
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6157
Practice Address - Country:US
Practice Address - Phone:702-927-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN15015251J00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care