Provider Demographics
NPI:1134139009
Name:MYERS, LYUDMILA M (PA)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NEIL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6556
Mailing Address - Country:US
Mailing Address - Phone:775-398-1981
Mailing Address - Fax:
Practice Address - Street 1:5250 NEIL RD STE 207
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6556
Practice Address - Country:US
Practice Address - Phone:775-398-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134139009Medicaid
NVP43301Medicare UPIN
NV002416170Medicaid