Provider Demographics
NPI:1669717732
Name:OSORIO, MARICLAR V (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:MARICLAR
Middle Name:V
Last Name:OSORIO
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:MRS
Other - First Name:MARICLAR
Other - Middle Name:O
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN,PMHNP-BC
Mailing Address - Street 1:6847 W CHARLESTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1648
Mailing Address - Country:US
Mailing Address - Phone:725-205-1578
Mailing Address - Fax:725-485-3749
Practice Address - Street 1:6847 W CHARLESTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1648
Practice Address - Country:US
Practice Address - Phone:725-205-1578
Practice Address - Fax:725-485-3749
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV881677363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty