Provider Demographics
NPI:1508014556
Name:SYME, SHANE R (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:R
Last Name:SYME
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:#B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:#B-18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:702-558-1522
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000344367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicaid
NVBH870ZMedicare PIN