Provider Demographics
NPI:1548842073
Name:FONG, BIANCA CAMILLE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:BIANCA CAMILLE
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 S EASTERN AVE STE 263
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2591
Mailing Address - Country:US
Mailing Address - Phone:702-938-0479
Mailing Address - Fax:702-938-1002
Practice Address - Street 1:8275 S EASTERN AVE STE 263
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2591
Practice Address - Country:US
Practice Address - Phone:702-938-0479
Practice Address - Fax:702-938-1002
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV839050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty