Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033460688 |
---|---|
Provider Name | Crisha Brannon |
First Address | Las Vegas, NV 89102-7179 |
Second Address | Las Vegas, NV 89102-7179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2012 |
Last Update Date | 23/09/2012 |