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NPI Code Detail

MEDICARE: PANISSARA NATALIE TEERAANUKUL NP

MEDICARE: PANISSARA NATALIE TEERAANUKUL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner810153NV

General Provider Information

NPI Number : 1033987052
Entity Type Code : Individual
Provider Name (Legal Business Name) : PANISSARA NATALIE TEERAANUKUL NP
Provider Business Mailing Address
First Line : 8905 W POST RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2429
Country : US
Telephone Number : 702-825-5553
Fax Number : 702-825-5552
Provider Business Practice Location Address
First Line : 8905 W POST RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2429
Country : US
Telephone Number : 702-825-5553
Fax Number : 702-825-5552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2023
Last Update Date : 09/15/2025

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Directions to “ PANISSARA NATALIE TEERAANUKUL NP” Practice Location

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