Provider Demographics
NPI:1033987052
Name:TEERAANUKUL, PANISSARA NATALIE
Entity Type:Individual
Prefix:
First Name:PANISSARA
Middle Name:NATALIE
Last Name:TEERAANUKUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N PECOS RD BLDG M
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2400
Mailing Address - Country:US
Mailing Address - Phone:702-262-0037
Mailing Address - Fax:702-272-2421
Practice Address - Street 1:701 N PECOS RD BLDG M
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2400
Practice Address - Country:US
Practice Address - Phone:702-262-0037
Practice Address - Fax:702-272-2421
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily