Provider Demographics
NPI:1811109465
Name:QUINONES, MICHELE ANNE (PAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNE
Last Name:QUINONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:RAYMUNDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 36310
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6310
Mailing Address - Country:US
Mailing Address - Phone:702-382-1599
Mailing Address - Fax:702-240-4962
Practice Address - Street 1:3425 CLIFF SHADOWS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-5112
Practice Address - Country:US
Practice Address - Phone:702-382-1599
Practice Address - Fax:702-240-4962
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19130OtherPA LICENSE
NVPA2855OtherLICENSE