Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | C52329 | NV |
Y | 222Z00000X | Podiatrist | C52329 | NV |
N | 224P00000X | Prosthetist | C52329 | NV |
NPI | 1043735871 |
---|---|
Provider Name | Alicia Laurie Purdum |
First Address | Las Vegas, NV 89145-2487 |
Second Address | Las Vegas, NV 89145-2487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |