Provider Demographics
NPI:1083089874
Name:DAGUMAN, MEILAN L (AGPCNP)
Entity Type:Individual
Prefix:
First Name:MEILAN
Middle Name:L
Last Name:DAGUMAN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-06
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002088363LP0808X
NVAPRN002088363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty