Provider Demographics
NPI:1275360158
Name:WASS, MIKAYLA LAUREN (FNP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LAUREN
Last Name:WASS
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 1:1071 ORO WAY
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-7515
Mailing Address - Country:US
Mailing Address - Phone:775-790-1188
Mailing Address - Fax:
Practice Address - Street 1:1673 LUCERNE ST STE A
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4388
Practice Address - Country:US
Practice Address - Phone:775-369-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily