=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801931761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN CROSBY CANSLER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3824 S JONES BLVD SUITE D
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89103-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-726-7171
-----------------------------------------------------
Fax | 702-726-7171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6935 ALIANTE PKWY # 104557
-----------------------------------------------------
City | NORTH LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89084-5818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-726-7230
-----------------------------------------------------
Fax | 702-726-7171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 9383
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------