Healthcare Provider Details

I. General information

NPI: 1558739110
Provider Name (Legal Business Name): MAILO K. BRANTNER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAILO K. YANG NP-C

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 W HORIZON RIDGE PKWY STE 209
HENDERSON NV
89052-2698
US

IV. Provider business mailing address

2298 W HORIZON RIDGE PKWY STE 209
HENDERSON NV
89052-2698
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-4050
  • Fax: 702-660-4069
Mailing address:
  • Phone: 702-660-4050
  • Fax: 702-660-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP10459
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberAPRN002004
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002004
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: