Provider Demographics
NPI:1275544959
Name:CRUET, CHARMAINE C (APN)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:C
Last Name:CRUET
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:CHARMAINE
Other - Middle Name:C
Other - Last Name:CRUET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN
Mailing Address - Street 1:6770 S MCCARRAN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6131
Mailing Address - Country:US
Mailing Address - Phone:775-851-1259
Mailing Address - Fax:
Practice Address - Street 1:6770 S. MCCARRAN
Practice Address - Street 2:#201
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-8194
Practice Address - Country:US
Practice Address - Phone:775-851-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP71941Medicare UPIN