MEDICARE: MEGAN MANASCO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	817768	NV
2	163W00000X	Registered Nurse	817768	NV

General Provider Information

NPI Number	:	1871146258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MANASCO CRNA

Provider Business Mailing Address
First Line	:	2656 N BUFFALO DR UNIT 1436
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4814
Country	:	US
Telephone Number	:	270-847-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2656 N BUFFALO DR UNIT 1436
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4814
Country	:	US
Telephone Number	:	702-882-8675
Fax Number	:

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

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	12/04/2019

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