Provider Demographics
NPI:1669964284
Name:RUIZ, SHARON PEDROCHE (FNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:PEDROCHE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 RIVER RIM CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6114
Mailing Address - Country:US
Mailing Address - Phone:702-423-5215
Mailing Address - Fax:
Practice Address - Street 1:9111 W RUSSELL RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1245
Practice Address - Country:US
Practice Address - Phone:702-312-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily