Provider Demographics
NPI:1528724804
Name:MUCHORI, KIMBERLY EUSEBIO (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EUSEBIO
Last Name:MUCHORI
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:KIMBERLY JANE
Other - Middle Name:EUSEBIO
Other - Last Name:MUCHORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845630363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily