Basic Information
| Provider Information | |||||||||
| NPI: | 1083975379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KWEK | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | LEANO | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023884428 | ||||||||
| FaxNumber: | 7023884312 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023884428 | ||||||||
| FaxNumber: | 7023884312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2012 | ||||||||
| LastUpdateDate: | 08/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | APN001371 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1083975379 | 01 | NV | NPI | OTHER | MK2628519 | 01 | NV | DEA | OTHER | APN001371 | 01 | NV | APN | OTHER | CS20110 | 01 | NV | NV STATE PHARMACY | OTHER | RN66413 | 01 | NV | RN | OTHER |