Provider Demographics
NPI:1598187643
Name:CORMICAN, AMANDA (PNP)
Entity Type:Individual
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First Name:AMANDA
Middle Name:
Last Name:CORMICAN
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:1840 E SAHARA AVE
Mailing Address - Street 2:#212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3741
Mailing Address - Country:US
Mailing Address - Phone:702-892-8007
Mailing Address - Fax:702-892-8193
Practice Address - Street 1:7180 CASCADE VALLEY CT
Practice Address - Street 2:#180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0449
Practice Address - Country:US
Practice Address - Phone:702-641-2150
Practice Address - Fax:702-228-1043
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics