Provider Demographics
NPI:1972560175
Name:KREUN, DANIEL (PAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KREUN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95306
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-5306
Mailing Address - Country:US
Mailing Address - Phone:702-948-8897
Mailing Address - Fax:702-549-3178
Practice Address - Street 1:861 CORONADO CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3992
Practice Address - Country:US
Practice Address - Phone:702-896-0940
Practice Address - Fax:702-896-6173
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA668363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ978257Medicaid
NV1972560175Medicaid
NVP00297291OtherRAILROAD MEDICARE
NVP25569Medicare UPIN
NV1972560175Medicaid