Provider Demographics
NPI:1023725363
Name:CHAVEZ MEDINA, REYSEL (MSN-APRN-FNP-C)
Entity type:Individual
Prefix:
First Name:REYSEL
Middle Name:
Last Name:CHAVEZ MEDINA
Suffix:
Gender:M
Credentials:MSN-APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 CORNWALL CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7706
Mailing Address - Country:US
Mailing Address - Phone:702-772-7705
Mailing Address - Fax:
Practice Address - Street 1:4415 HAWTHORNE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4605
Practice Address - Country:US
Practice Address - Phone:702-722-3314
Practice Address - Fax:702-722-3752
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022837363LF0000X
NV818580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily