Provider Demographics
NPI:1376013540
Name:KONO-BOELTER, JANAL HIFUMI (APRN)
Entity type:Individual
Prefix:
First Name:JANAL
Middle Name:HIFUMI
Last Name:KONO-BOELTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANAL
Other - Middle Name:HIFUMI
Other - Last Name:DEMELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1825 E WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4547
Mailing Address - Country:US
Mailing Address - Phone:702-612-4790
Mailing Address - Fax:
Practice Address - Street 1:1825 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4547
Practice Address - Country:US
Practice Address - Phone:702-361-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV815833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily