Provider Demographics
NPI:1174501720
Name:VANBEUGE, SUSAN S (APN)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:VANBEUGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-804-9486
Mailing Address - Fax:702-802-3435
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-804-9486
Practice Address - Fax:702-802-3435
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502795Medicaid
NVAPN00742OtherPHARMACY/CDS
NVAPN00742OtherPHARMACY/CDS
NVAPN00742OtherPHARMACY/CDS
NV100502795Medicaid