Shandana Mergerson

Key facts

NPI

1831752153

Entity type

Individual (NPI type 1)

Primary specialty

Family Health Clinical Nurse Specialist 364SF0001X

License

667888 (NV)

Practice address

11830 Newport View St
Las Vegas, NV 89183-5660

Phone

(702) 752-2057

NPI assigned

Apr 22, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 11, 2019.

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1831752153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11830 NEWPORT VIEW ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891835660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11830 NEWPORT VIEW ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891835660",
            "telephone_number": "702-752-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERGERSON",
        "first_name": "SHANDANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NV",
            "license": "667888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1900209960",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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