Provider Demographics
NPI:1790428712
Name:ANDERSON, SUSAN (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 SUNRIDGE HEIGHTS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5043
Mailing Address - Country:US
Mailing Address - Phone:702-553-3635
Mailing Address - Fax:833-973-5084
Practice Address - Street 1:2739 SUNRIDGE HEIGHTS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5043
Practice Address - Country:US
Practice Address - Phone:702-553-3635
Practice Address - Fax:833-973-5084
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV813670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV813670OtherSTATE LICENSE
NV1790428712Medicaid