Basic Information
| Provider Information | |||||||||
| NPI: | 1306290341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LUNA | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 W CHARLESTON BLVD | ||||||||
| Address2: | #221 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024447744 | ||||||||
| FaxNumber: | 7024447898 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 W HORIZON RIDGE PKWY | ||||||||
| Address2: | #221 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890525013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022339222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN002126 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | APRN002126 | 01 | NV | APRN LICENSE | OTHER |