Basic Information
| Provider Information | |||||||||
| NPI: | 1598407652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RELUCIO | ||||||||
| FirstName: | RUTH ALMA VANESSA | ||||||||
| MiddleName: | LIM | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S BRUCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891691778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 S BRUCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891691778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2022 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 853489 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.