Healthcare Provider Details

I. General information

NPI: 1609279629
Provider Name (Legal Business Name): DEANNA ST CYR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 S EASTERN AVE STE 1300
LAS VEGAS NV
89119-7826
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-9930
  • Fax:
Mailing address:
  • Phone: 702-838-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001835
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: