Provider Demographics
NPI:1528352341
Name:PHAN, LANANH (NP)
Entity type:Individual
Prefix:
First Name:LANANH
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2621W HORIZON RIDGE PKWY 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2895
Mailing Address - Country:US
Mailing Address - Phone:702-803-5534
Mailing Address - Fax:702-550-4920
Practice Address - Street 1:2621 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2895
Practice Address - Country:US
Practice Address - Phone:702-803-5534
Practice Address - Fax:702-550-4920
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR190658363LF0000X
CA22208363LF0000X, 363LF0000X
NVAPRN001922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1528352341Medicaid
NV1528352341Medicaid