Provider Demographics
NPI:1033625330
Name:MALIAKAL, GRENY (APRN)
Entity Type:Individual
Prefix:
First Name:GRENY
Middle Name:
Last Name:MALIAKAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W HORIZON RIDGE PKWY
Mailing Address - Street 2:B304 #668
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4477
Mailing Address - Country:US
Mailing Address - Phone:702-868-8387
Mailing Address - Fax:702-314-9134
Practice Address - Street 1:6088 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1780
Practice Address - Country:US
Practice Address - Phone:702-380-4242
Practice Address - Fax:702-380-4141
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002667363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner