Provider Demographics
NPI:1326938093
Name:BERMUDEZ, MICHELLE MAE ELLORIMO (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE MAE
Middle Name:ELLORIMO
Last Name:BERMUDEZ
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 1:7911 AVALON ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6187
Mailing Address - Country:US
Mailing Address - Phone:702-338-1800
Mailing Address - Fax:
Practice Address - Street 1:7911 AVALON ISLAND ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6187
Practice Address - Country:US
Practice Address - Phone:702-338-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV868013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse