Individual ProviderMichelle BastaracheNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address6460 Medical Center St, Las Vegas, NV 89148-2406(702) 255-6647(702) 821-6400PECOS EnrollmentBased on the most recent information from CMS, provider Michelle Bastarache is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1053912790Provider TypeIndividualFull NameBastarache, MichelleCredentialNPGenderFemaleSole ProprietorNoEnumeration Date11/7/2020Last Updated11/7/2020Contact InformationPractice LocationPractice Address6460 Medical Center St, Las Vegas, NV 89148-2406Phone(702) 255-6647FaxUnlisted FaxMailing LocationMailing Address6422 Mustang Spring Ave, Las Vegas, NV 89139-7200Phone(702) 821-6400FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense831764Nevada