Provider Demographics
NPI:1184358830
Name:SOTELO, JOANA (NP)
Entity type:Individual
Prefix:
First Name:JOANA
Middle Name:
Last Name:SOTELO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 OZZIE HARRIET AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-1722
Mailing Address - Country:US
Mailing Address - Phone:702-501-3099
Mailing Address - Fax:
Practice Address - Street 1:6530 OZZIE HARRIET AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-1722
Practice Address - Country:US
Practice Address - Phone:702-501-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN72350163WE0003X
NV858725363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency