Provider Demographics
NPI:1528566460
Name:MANDEL, GLORIA SANTIAGUEL (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:SANTIAGUEL
Last Name:MANDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:DE LEON
Other - Last Name:SANTIAGUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:191 MESCALERO TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1037
Mailing Address - Country:US
Mailing Address - Phone:702-630-9711
Mailing Address - Fax:
Practice Address - Street 1:191 MESCALERO TRL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1037
Practice Address - Country:US
Practice Address - Phone:702-630-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner