Healthcare Provider Details

I. General information

NPI: 1972560175
Provider Name (Legal Business Name): DANIEL KREUN P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORONADO CENTER DR SUITE 200
HENDERSON NV
89052-3992
US

IV. Provider business mailing address

PO BOX 95306
LAS VEGAS NV
89193-5306
US

V. Phone/Fax

Practice location:
  • Phone: 702-896-0940
  • Fax: 702-896-6173
Mailing address:
  • Phone: 702-948-8897
  • Fax: 702-549-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA668
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: