Provider Demographics
NPI:1649211095
Name:MEINER, SUE E (APN, EDD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:E
Last Name:MEINER
Suffix:
Gender:F
Credentials:APN, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 S BUFFALO DR
Mailing Address - Street 2:A101-172
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7479
Mailing Address - Country:US
Mailing Address - Phone:702-878-8252
Mailing Address - Fax:702-878-9096
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-878-8252
Practice Address - Fax:702-878-9096
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100792OtherGROUP
NV100503698Medicaid
NV39640OtherMEDICARE ORIGINAL
NVP00285923OtherMC RR
NV100792OtherGROUP