Basic Information
| Provider Information | |||||||||
| NPI: | 1851531305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANLEUVEN | ||||||||
| FirstName: | ANASTASIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3157 N RAINBOW BLVD | ||||||||
| Address2: | #518 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891084578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 S CIMARRON RD | ||||||||
| Address2: | #270 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2009 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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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 | 363AS0400X | PA1145 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | V115285 | 01 | NV | MEDICARE PTAN | OTHER | MJ1921786 | 01 | NV | DEA | OTHER | PA1145 | 01 | NV | NEVADA STATE BOARD | OTHER |