Provider Demographics
NPI:1902352644
Name:ATIENZA, MANUEL SISON (NP)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:SISON
Last Name:ATIENZA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:MANUEL
Other - Middle Name:SISON
Other - Last Name:ATIENZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2268 TEDESCA DRIVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-353-2178
Mailing Address - Fax:
Practice Address - Street 1:2268 TEDESCA DRIVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-353-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily