MEDICARE: MRS. SUK HI ROSS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN75886	NV

General Provider Information

NPI Number	:	1437100054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUK HI ROSS CRNA

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE
Second Line	:	337
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-227-4040
Fax Number	:	702-227-4727

Provider Business Practice Location Address
First Line	:	3835 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7125
Country	:	US
Telephone Number	:	702-880-4193
Fax Number	:	702-880-4197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/11/2016

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