Provider Demographics
NPI:1558739110
Name:BRANTNER, MAILO K (NP-C)
Entity Type:Individual
Prefix:
First Name:MAILO
Middle Name:K
Last Name:BRANTNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MAILO
Other - Middle Name:K
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2298 W HORIZON RIDGE PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2698
Mailing Address - Country:US
Mailing Address - Phone:702-660-4050
Mailing Address - Fax:702-660-4069
Practice Address - Street 1:2298 W HORIZON RIDGE PKWY STE 209
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2698
Practice Address - Country:US
Practice Address - Phone:702-660-4050
Practice Address - Fax:702-660-4069
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP10459363LF0000X
NVAPRN002004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558739110Medicaid
NVPENDINGMedicaid