Individual
DANIEL S VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2650 N TENAYA WAY # 301, LAS VEGAS, NV 89128-1102
(702) 258-5521
(702) 938-0137
Mailing address
2650 N TENAYA WAY, 301, LAS VEGAS, NV 89128-1102
(702) 258-5521
(702) 938-0137
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 1323
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FU392Y
MEDICARE PTAN
NV
01
—
PA 1323
PA LICENSE
NV
Enumeration date
01/04/2012
Last updated
12/09/2013
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