MEDICARE: SUE E MEINER APN, EDD

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	363L00000X	Nurse Practitioner	APN000558	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	39640	OTHER	NV	MEDICARE ORIGINAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100792	OTHER	NV	GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00285923	OTHER	NV	MC RR

General Provider Information

NPI Number	:	1649211095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE E MEINER APN, EDD

Provider Business Mailing Address
First Line	:	4045 S BUFFALO DR
Second Line	:	A101-172
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7479
Country	:	US
Telephone Number	:	702-878-8252
Fax Number	:	702-878-9096

Provider Business Practice Location Address
First Line	:	600 S RANCHO DR
Second Line	:	SUITE 113
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-878-8252
Fax Number	:	702-878-9096

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/20/2010

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Directions to “ SUE E MEINER APN, EDD” Practice Location

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