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Provider Information for 1568027621

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1568027621

Calendar   Last Updated:  2019-05-04
  Certification Date: 


Name Value
NPI 1568027621
Enumeration Date 2019-05-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 50843
SPARKS, NV 89435-0843
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 5945 S LOS ALTOS PKWY STE 101
SPARKS, NV 89436-2503
United States

Phone: 775-354-1380 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 106S00000X - Behavior Technician NV