Provider Demographics
NPI:1346702784
Name:KRANTZ, ERIC (APRN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:HERSCH
Other - Last Name:KRANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2020 WELLNESS WAY STE 504
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4145
Mailing Address - Country:US
Mailing Address - Phone:561-271-3491
Mailing Address - Fax:
Practice Address - Street 1:2020 WELLNESS WAY STE 504
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4145
Practice Address - Country:US
Practice Address - Phone:561-271-3491
Practice Address - Fax:702-259-9595
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818687208200000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV818687OtherNEVADA APRN LICENSE NUMBER