Provider Demographics
NPI:1689935470
Name:GARR, SUSAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:GARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:GARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6830 W OQUENDO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-385-9933
Mailing Address - Fax:702-385-4586
Practice Address - Street 1:6830 W OQUENDO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2539
Practice Address - Country:US
Practice Address - Phone:702-385-9933
Practice Address - Fax:702-385-4586
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4092363LA2200X
NV001378363LA2200X
HI280363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health