Provider Demographics
NPI:1255732483
Name:SHANKS, MARGARITA S (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:S
Last Name:SHANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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:
Practice Address - Street 1:1302 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0246
Practice Address - Country:US
Practice Address - Phone:702-657-9555
Practice Address - Fax:702-657-9040
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60101218363AM0700X
NVPA2210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1255732483Medicaid
NVPA2210OtherSTATE LICENSE