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NPI Code Detail

MEDICARE: MAILO K. BRANTNER NP-C

MEDICARE: MAILO K. BRANTNER NP-C
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 PractitionerCNP10459MN
2207RG0100XGastroenterology PhysicianAPRN002004NV
3363LF0000XFamily Nurse PractitionerAPRN002004NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558739110
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAILO K. BRANTNER NP-C
Provider Business Mailing Address
First Line : 2298 W HORIZON RIDGE PKWY STE 209
Second Line :
City : HENDERSON
State : NV
Zip : 89052-2698
Country : US
Telephone Number : 702-660-4050
Fax Number : 702-660-4069
Provider Business Practice Location Address
First Line : 2298 W HORIZON RIDGE PKWY STE 209
Second Line :
City : HENDERSON
State : NV
Zip : 89052-2698
Country : US
Telephone Number : 702-660-4050
Fax Number : 702-660-4069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2015
Last Update Date : 12/08/2025

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