Provider Demographics
NPI:1538585005
Name:LIM GO, GEMMA (APRN)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:LIM GO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:ROCERO
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:702-835-9870
Mailing Address - Fax:702-835-9883
Practice Address - Street 1:6850 N DURANGO DR STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-835-9870
Practice Address - Fax:702-835-9883
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001585363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538585005Medicaid