Unknown Individual – Obstetrics & Gynecology Nurse Practitioner, NPI 1417912841

Obstetrics & Gynecology Nurse Practitioner

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Obstetrics & Gynecology Nurse Practitioner. They hold a License No. APN000881 (NV). The NPI Number for Unknown Individual is 1417912841

Main info

Organization

Inactive

31 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417912841

Phone

(702) 750-3800

Address

PO BOX 35380

Deactivation Date

16 December 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7028778660

Graduation Year

1995 (31 years ago)

PAC ID

2769573831

Group Practice PAC ID

4981687779

Professional Enrollment ID

I20070803000204

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

McCarran International Airport, 5757, Wayne Newton Boulevard, Enterprise, Clark County, Nevada, 89154, United States
LAS VEGAS, NV 891335380
Phone: (702) 750-3800
Type: Mailing
7061, Grand Montecito Parkway, Las Vegas, Clark County, Nevada, 89149, United States
LAS VEGAS, NV 891490287
Phone: (702) 750-3800
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89133)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4981687779View full group profile

Name	Specialty	State
PATRICIA MAY B. LACSINA (M.D.)	Family Practice	TX
JACKI MARIE DEGUZMAN (M.D.)	Internal Medicine	NV
JUWAUN HINKLE (PA-C)	Physician Assistant	NV
NATOYA N STEWART (APRN)	-	KY
MRS. LAUREN BRANCH PARKER (APRN, FNP-C)	Nurse Practitioner	NV
GENGHIS PORTILLO (M.D.)	-	NV
ARIANA MONIN (APRN)	Nurse Practitioner	NV
CARL ALLEN (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	NV
DENISHA LANG (FNP)	Nurse Practitioner	IL
DR. MATTHEW TYLER RADDUE (M.D.)	-	NV

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?

Yes. Unknown Individual is listed with NPI 1417912841 in the public NPI dataset.

Is Unknown Individual's NPI deactivated?

The extract indicates Unknown Individual is not in an active NPI state.

What is Unknown Individual's primary classification?

Obstetrics & Gynecology Nurse Practitioner is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Las Vegas, Nevada; more addresses can appear in NPPES.

How many locations tie to this NPI?

2 practice locations appear in the available data.