Healthcare Provider Details

I. General information

NPI: 1952512147
Provider Name (Legal Business Name): MIEKO SUZUKI MCLAFFERTY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FRESNO ST STE 100
FRESNO CA
93721-1327
US

IV. Provider business mailing address

9749 PINE THICKETT AVE
LAS VEGAS NV
89147-6747
US

V. Phone/Fax

Practice location:
  • Phone: 559-263-9648
  • Fax: 559-263-9777
Mailing address:
  • Phone: 702-233-1251
  • Fax: 702-255-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: