Provider Demographics
NPI:1073709424
Name:LLASUS, LUDY SM (APN)
Entity Type:Individual
Prefix:
First Name:LUDY
Middle Name:SM
Last Name:LLASUS
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 1:2481 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0832
Mailing Address - Country:US
Mailing Address - Phone:702-838-0400
Mailing Address - Fax:
Practice Address - Street 1:2481 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0832
Practice Address - Country:US
Practice Address - Phone:702-838-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV24-02838Medicaid
NV24-02838Medicaid