Provider Demographics
NPI:1710420542
Name:MANIAGO, VERNON (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:MANIAGO
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 EL CAMINO AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4266
Mailing Address - Country:US
Mailing Address - Phone:702-380-3210
Mailing Address - Fax:702-380-3212
Practice Address - Street 1:2851 EL CAMINO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4266
Practice Address - Country:US
Practice Address - Phone:702-600-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002361363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care