Provider Demographics
NPI:1285057562
Name:ZALAN, ELENA (PA-C)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ZALAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:ALISOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 MARKS ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-383-6210
Mailing Address - Fax:702-435-7050
Practice Address - Street 1:525 MARKS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-383-6210
Practice Address - Fax:702-435-7050
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1487363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1285057562Medicaid
NVV111126Medicare PIN