Provider Information for 1134638190
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KELSEE DREW
Sex: Female
NPI: 1134638190
Last Updated: 2023-12-13
Certification Date: 2023-12-01
Certification Date: 2023-12-01
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134638190 | ||||||||
| Enumeration Date | 2017-09-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6160 RUMRILL ST UNIT 105 LAS VEGAS, NV 89113-7104 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1555 E FLAMINGO RD STE 125 LAS VEGAS, NV 89119-5259 United States Phone: 702-751-4801 | Fax: | ||||||||
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