Provider Demographics
NPI:1003249368
Name:EDANO, LOTIS GAY PERILLA (APRN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:LOTIS GAY
Middle Name:PERILLA
Last Name:EDANO
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S BRUCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1778
Mailing Address - Country:US
Mailing Address - Phone:702-732-2438
Mailing Address - Fax:
Practice Address - Street 1:2545 S BRUCE ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1778
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-733-7876
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001551363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ836163Medicaid
NV1003249368Medicaid
NVHM649ZMedicare PIN
NV1003249368Medicaid