Basic Information
| Provider Information | |||||||||
| NPI: | 1306824057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENASCHE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10625 ARGENTS HILL DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891347353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028604232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 926 W. SUNSET RD. WELL HEAKTH QUALITY CARE | ||||||||
| Address2: | # 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022553547 | ||||||||
| FaxNumber: | 7029212419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APN00237 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 002402092 | 05 | NV | MEDICAID | CS03171 | 01 | NV | PHARMACY/CDS | OTHER | MM0843208 | 01 | NV | DEA | OTHER |