Healthcare Provider Details

I. General information

NPI: 1659991578
Provider Name (Legal Business Name): JOHN GLENN MCLACHLAN APRN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN GLENN MCLACHLAN APRN FNP

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 FAIRWAY DR
BOULDER CITY NV
89005-3429
US

IV. Provider business mailing address

764 FAIRWAY DR
BOULDER CITY NV
89005-3429
US

V. Phone/Fax

Practice location:
  • Phone: 702-686-5706
  • Fax:
Mailing address:
  • Phone: 702-686-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN54510
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN065812
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN104908
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN54510
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN065812
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN104908
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN54510
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN065812
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN104908
License Number StateCO
# 10
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number830024
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: