Provider Demographics
NPI:1760977029
Name:MIYASHIRO, ERIN LIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LIN
Last Name:MIYASHIRO
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1000 S RAINBOW BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-255-4200
Practice Address - Fax:702-255-0260
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM03614207Q00000X
NV830871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV830871OtherSTATE LICENSE
NV1760977029Medicaid