MEDICARE: NICK ALLAN TANGEMAN MSW, LADC

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
1	104100000X	Social Worker	6095-S	NV
2	104100000X	Social Worker	007004	IA
3	171M00000X	Case Manager/Care Coordinator
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	01455-L	NV

General Provider Information

NPI Number	:	1245514504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK ALLAN TANGEMAN MSW, LADC

Provider Business Mailing Address
First Line	:	9465 W POST RD
Second Line	:	2044
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5782
Country	:	US
Telephone Number	:	319-230-7336
Fax Number	:

Provider Business Practice Location Address
First Line	:	9465 W POST RD
Second Line	:	2044
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5782
Country	:	US
Telephone Number	:	319-230-7336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	05/05/2017

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