GREGORY LOTHAR PEISTRUP (NPI# 1366624843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366624843 |
| Entity Type | Individual |
| Full Name | GREGORY LOTHAR PEISTRUP |
| Credential | APRN |
| Practice Address |
4835 S Durango Dr Las Vegas Las Vegas NV 89147-8171 |
| Mailing Address |
Po Box 15645 Las Vegas Las Vegas NV 89114-5645 |
| Practice Telephone | 7028778600 |
| Mailing Telephone | 7025793270 |
| Mailing Fax Number | 7026774651 |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2015-11-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WE0003X |
Registered Nurse Specialization: Emergency |
RN 26532 | NV | Nursing Service Providers |
| N | 163WF0300X |
Registered Nurse Specialization: Flight |
EMS RN 26299 | NV | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APN001005 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | SMA MEDICAID | 1366624843 | 01 |
| NV | SMA MEDICARE | V111997 | 01 |
| Street Address |
4835 S DURANGO DR LAS VEGAS |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89147-8171 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427020759 | Dmitriy Kosyagin | Internal Medicine | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2006-02-02 |
| 1376010082 | Jade Weeks | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2018-10-31 |
| 1245707090 | Kellie Mcgrue Hawthorne | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2018-10-30 |
| 1588154561 | Joseph T Coulson | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147 | 2018-05-15 |
| 1679075519 | Rizza Marie Cruz Tawatao | Nurse Practitioner | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2018-03-07 |
| 1942715636 | Logan Tim Belnap | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2017-12-05 |
| 1356727754 | Wendy L Martinez | Nurse Practitioner | 4835 S Durango Dr, Las Vegas, NV 89147 | 2015-08-07 |
| 1346629896 | Justine Suba-cohen | Family Medicine | 4835 S Durango Dr, Las Vegas, NV 89147 | 2015-05-29 |
| 1972998391 | Tony Tan | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2015-04-02 |
| 1013300714 | Juwaun Hinkle | Physician Assistant | 4835 S Durango Dr, Las Vegas, NV 89147-8171 | 2015-03-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619593621 | Ata Group Lv | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 10170 W Tropicana Ave Ste 156-211, Las Vegas, NV 89147 | 2020-06-25 |
| 1104474022 | Jacklyn Siagatonu | Behavior Technician | 7125 Grand Montecito Parkway, Las Vegas Nv, N Las Vegas, NV 89147 | 2019-09-04 |
| 1700388253 | Pr Acquisition Corporation | Clinic/Center | 9892 W Flamingo Road, Las Vegas, NV 89147 | 2018-03-01 |
| 1629578836 | Jonathan Balagot Dizon | Optometrist | 4160 S Durango Dr, Las Vegas, NV 89147 | 2018-02-14 |
| 1346751526 | Ignite Teen Treatment, LLC | Clinic/Center | 3722 Lone Mesa Dr, Las Vegas, NV 89147 | 2017-10-16 |
| 1306365275 | Diversified Behavioral Health Services LLC | Community/Behavioral Health | 9636 W.cherokee Ave, Las Vegas, NV 89147 | 2017-09-12 |
| 1356874713 | A8a Personal Care Solution LLC | In Home Supportive Care | 8879 West Flamingo, Ste 101, Las Vegas, NV 89147 | 2017-04-04 |
| 1154782191 | Ma Leah Roble Maravillas | Behavioral Analyst | 9999 W Katie Ave Suite 1313, Las Vegas, NV 89147 | 2016-03-18 |
| 1285010959 | Samantha Lauren Pope | Specialist | 9353 W. Twain Ave, Apt 113, Las Vegas, NV 89147 | 2015-08-05 |
| 1215311980 | Daniel Dorado | Marriage & Family Therapist | 9848 Gallo Dr, Las Vegas, NV 89147 | 2015-07-13 |
| Find all providers in zip 89147 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396651 | Alma F Talavera | Nurse Practitioner | 5982 Juniper Falls Ave, Las Vegas, NV 89130-2827 | 2020-11-06 |
| 1154922300 | Reynaly Campos | Nurse Practitioner | 10680 Spruce Bough St, Las Vegas, NV 89183-4631 | 2020-11-04 |
| 1811596463 | Carolina Salaberrios | Nurse Practitioner | 8440 W Lake Mead Blvd Ste 111, Las Vegas, NV 89128-7648 | 2020-10-23 |
| 1851990840 | John Marius Agravio Tolentino | Nurse Practitioner | 3557 Winter Wren St, Las Vegas, NV 89122-3539 | 2020-10-21 |
| 1811596760 | Emmelyn Pineda Rivas | Nurse Practitioner | 7852 Lovely Pine Pl, Las Vegas, NV 89143-4431 | 2020-10-21 |
| 1659979052 | Francis Torres | Nurse Practitioner | 10010 Fort Pike St, Las Vegas, NV 89178-7543 | 2020-10-16 |
| 1144828849 | Julio Arvie Mata Madarazo Jr. | Nurse Practitioner | 6284 Canvasback Ave, Las Vegas, NV 89122-3545 | 2020-10-14 |
| 1104424076 | Khelsey Macaspac | Nurse Practitioner | 6446 Dunns River St, Las Vegas, NV 89166-8064 | 2020-10-13 |
| 1912505199 | Angelica Villahermosa | Nurse Practitioner | 8115 Dancing Bull Ct, Las Vegas, NV 89139-6702 | 2020-10-11 |
| 1467050625 | Ruby Borja | Nurse Practitioner | 7329 Perkins Hill St, Las Vegas, NV 89166-6505 | 2020-10-10 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.