MEDICARE: TAMMY A MACANAS PRSS-S

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	175T00000X	Peer Specialist	PRSS-SUP-5081	NV

General Provider Information

NPI Number	:	1588498679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY A MACANAS PRSS-S

Provider Business Mailing Address
First Line	:	4800 ALPINE PL STE 12
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4086
Country	:	US
Telephone Number	:	702-257-8199
Fax Number	:	702-257-8299

Provider Business Practice Location Address
First Line	:	4800 ALPINE PL STE 12
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4086
Country	:	US
Telephone Number	:	702-257-8199
Fax Number	:	702-257-8299

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	03/04/2026

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