Provider Demographics
NPI:1053336784
Name:MCCRAW, JOAN (MSN, FNP, APRN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:MSN, FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0566
Mailing Address - Country:US
Mailing Address - Phone:702-341-0311
Mailing Address - Fax:702-254-1621
Practice Address - Street 1:5530 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-341-0311
Practice Address - Fax:702-254-1621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN00386363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402021Medicaid
NVP39185Medicare UPIN