Provider Demographics
NPI:1043068661
Name:AREVALO-MORENO, ANGIE CAROLINA (RN)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:CAROLINA
Last Name:AREVALO-MORENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 SPERANZA DEL SOL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4073
Mailing Address - Country:US
Mailing Address - Phone:702-517-1325
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3514
Practice Address - Country:US
Practice Address - Phone:702-982-3292
Practice Address - Fax:702-982-5286
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV830427163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health