Provider Demographics
NPI:1215237110
Name:GAERLAN, MARY-GRACE G (APRN)
Entity type:Individual
Prefix:
First Name:MARY-GRACE
Middle Name:G
Last Name:GAERLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY-GRACE
Other - Middle Name:G
Other - Last Name:MABASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2255 RENAISSANCE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6751
Mailing Address - Country:US
Mailing Address - Phone:702-901-4880
Mailing Address - Fax:702-434-3530
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN 1246363L00000X
NVTAPN700611363LF0000X
NVAPRN001246364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215237110Medicaid
NVEP218ZMedicare PIN
NVEP218YMedicare PIN