Provider Demographics
NPI:1922721406
Name:ADVANCED PRACTITIONER LLC
Entity Type:Organization
Organization Name:ADVANCED PRACTITIONER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARK JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CULANAG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:510-590-2779
Mailing Address - Street 1:1810 E SAHARA AVE STE 212
Mailing Address - Street 2:#2207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3707
Mailing Address - Country:US
Mailing Address - Phone:510-590-2779
Mailing Address - Fax:
Practice Address - Street 1:6843 W TROPICANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4923
Practice Address - Country:US
Practice Address - Phone:510-590-2779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care