Provider Demographics
NPI:1871146258
Name:MANASCO, MEGAN (CRNA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MANASCO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 N BUFFALO DR UNIT 1436
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4814
Mailing Address - Country:US
Mailing Address - Phone:270-847-7431
Mailing Address - Fax:
Practice Address - Street 1:2656 N BUFFALO DR UNIT 1436
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4814
Practice Address - Country:US
Practice Address - Phone:702-882-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV817768367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse