Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033755764 |
---|---|
Provider Name | Asia Jefferson |
First Address | Henderson, NV 89014-6835 |
Second Address | Las Vegas, NV 89130-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2019 |
Last Update Date | 18/11/2019 |