Provider Demographics
NPI:1003894718
Name:SUITER, PHYLLIS A (APN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:SUITER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 FIRE MESA ST
Mailing Address - Street 2:#180, FAMILY PRACTICE CENTER
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9016
Mailing Address - Country:US
Mailing Address - Phone:702-992-6888
Mailing Address - Fax:702-992-6880
Practice Address - Street 1:2410 FIRE MESA ST
Practice Address - Street 2:#180, FAMILY PRACTICE CENTER
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9016
Practice Address - Country:US
Practice Address - Phone:702-992-6888
Practice Address - Fax:702-992-6880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPN0177OtherPHARMACY/CDS
NVAPN0177OtherPHARMACY/CDS
NVS84474Medicare UPIN
NVMS1166304OtherDEA