Provider Demographics
NPI:1023568037
Name:MEILAN L DAGUMAN APRN PLLC
Entity Type:Organization
Organization Name:MEILAN L DAGUMAN APRN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEILAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAGUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-815-6080
Mailing Address - Street 1:7104 CARMEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3430
Mailing Address - Country:US
Mailing Address - Phone:702-815-6350
Mailing Address - Fax:702-623-5995
Practice Address - Street 1:4560 S EASTERN AVE STE 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-994-7267
Practice Address - Fax:702-623-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LP0808X
NV363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty