Healthcare Provider Details

I. General information

NPI: 1396364055
Provider Name (Legal Business Name): ANASTASIA LEE MERCADO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANASTASIA JENNA LEE APRN

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 S PECOS RD STE 3500
HENDERSON NV
89074-7185
US

IV. Provider business mailing address

9089 S PECOS RD STE 3500
HENDERSON NV
89074-7185
US

V. Phone/Fax

Practice location:
  • Phone: 702-550-7025
  • Fax:
Mailing address:
  • Phone: 702-550-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number830020
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number830020
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: