Provider Demographics
NPI:1033987052
Name:TEERAANUKUL, PANISSARA NATALIE (NP)
Entity type:Individual
Prefix:
First Name:PANISSARA
Middle Name:NATALIE
Last Name:TEERAANUKUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 W POST RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2429
Mailing Address - Country:US
Mailing Address - Phone:702-825-5553
Mailing Address - Fax:702-825-5552
Practice Address - Street 1:8905 W POST RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2429
Practice Address - Country:US
Practice Address - Phone:702-825-5553
Practice Address - Fax:702-825-5552
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily