Provider Demographics
NPI:1760723092
Name:MCDONALD, ANNELEISA GAIL (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANNELEISA
Middle Name:GAIL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:175 CROOKED PUTTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5228
Mailing Address - Country:US
Mailing Address - Phone:702-268-8900
Mailing Address - Fax:702-664-6729
Practice Address - Street 1:6655 W SAHARA AVE STE B200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2832
Practice Address - Country:US
Practice Address - Phone:702-268-8900
Practice Address - Fax:702-664-6729
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2022-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV49277163W00000X
NVAPRN002927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760723092Medicaid