Provider Demographics
NPI:1104500735
Name:HENSON, MIRA JANINE CANLAS (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MIRA JANINE
Middle Name:CANLAS
Last Name:HENSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:253 RUSTIC CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5202
Mailing Address - Country:US
Mailing Address - Phone:858-531-1870
Mailing Address - Fax:
Practice Address - Street 1:2020 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4144
Practice Address - Country:US
Practice Address - Phone:702-432-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV868163363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner