Provider Demographics
NPI:1093885519
Name:GAINER, VANCE GLENN JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:VANCE
Middle Name:GLENN
Last Name:GAINER
Suffix:JR
Gender:M
Credentials:CRNA
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Other - First Name:
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Mailing Address - Street 1:3157 N RAINBOW BLVD
Mailing Address - Street 2:#250
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-308-2711
Mailing Address - Fax:
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000229367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered