Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME 112582 | FL |
N | 111NI0900X | Internist | ME 112582 | FL |
Y | 207RR0500X | Rheumatology | 15845 | NV |
N | 207RR0500X | Rheumatology | ME 112582 | FL |
N | 208000000X | Pediatrician | ME 112582 | FL |
N | 2080P0216X | Pediatric Rheumatologist | ME 112582 | FL |
NPI | 1841491917 |
---|---|
Provider Name | Sandra Pagnussat |
First Address | Las Vegas, NV 89114-5645 |
Second Address | Las Vegas, NV 89103-0111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 01/07/2015 |