Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003237017 |
---|---|
Provider Name | Chantel Dussett |
First Address | Las Vegas, NV 89142-3628 |
Second Address | North Las Vegas, NV 89030-3930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2013 |
Last Update Date | 30/11/2015 |