Provider Demographics
NPI:1366203325
Name:POGOSOVA, ANAIT (LPN)
Entity type:Individual
Prefix:MISS
First Name:ANAIT
Middle Name:
Last Name:POGOSOVA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:ANAIT
Other - Middle Name:SURP
Other - Last Name:POGOSOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3644 S FORT APACHE RD APT 1029
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-3420
Mailing Address - Country:US
Mailing Address - Phone:323-251-4198
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 218
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5124
Practice Address - Country:US
Practice Address - Phone:702-436-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV867806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse