Provider Demographics
NPI:1881099026
Name:PRATT, BRENDA (APN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2313
Mailing Address - Country:US
Mailing Address - Phone:702-410-2970
Mailing Address - Fax:702-410-2974
Practice Address - Street 1:3196 S MARYLAND PKWY STE 207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2313
Practice Address - Country:US
Practice Address - Phone:702-410-2970
Practice Address - Fax:702-410-2974
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily