Provider Demographics
NPI:1679817274
Name:DEL ROSARIO, NOEMI NOBLE
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:NOBLE
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:NOBLE
Other - Last Name:DEL ROSARIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1905 MCDANIEL ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7170
Mailing Address - Country:US
Mailing Address - Phone:702-868-7777
Mailing Address - Fax:702-260-0333
Practice Address - Street 1:1905 MCDANIEL ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7170
Practice Address - Country:US
Practice Address - Phone:702-868-7777
Practice Address - Fax:702-260-0333
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679817274Medicaid