Provider Demographics
NPI:1346649514
Name:CUBIL, SUSAN BAYBAY (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BAYBAY
Last Name:CUBIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BAYBAY
Other - Last Name:CUBIL-PAGTAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5150 MASOTTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3888
Mailing Address - Country:US
Mailing Address - Phone:410-967-9211
Mailing Address - Fax:
Practice Address - Street 1:10530 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:#150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4379
Practice Address - Country:US
Practice Address - Phone:410-967-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily