Healthcare Provider Details

I. General information

NPI: 1073709424
Provider Name (Legal Business Name): LUDY SM LLASUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 PROFESSIONAL CT
LAS VEGAS NV
89128-0832
US

IV. Provider business mailing address

2481 PROFESSIONAL CT
LAS VEGAS NV
89128-0832
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-0400
  • Fax:
Mailing address:
  • Phone: 702-838-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000677
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: