Provider Demographics
NPI:1588178941
Name:MACADAAN, GLAISSA
Entity Type:Individual
Prefix:
First Name:GLAISSA
Middle Name:
Last Name:MACADAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 SERENO SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6615
Mailing Address - Country:US
Mailing Address - Phone:702-815-4754
Mailing Address - Fax:
Practice Address - Street 1:6332 SERENO SPRINGS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6615
Practice Address - Country:US
Practice Address - Phone:702-815-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN76299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse