Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 620 | NV |
NPI | 1013688514 |
---|---|
Provider Name | Darcy Medlin |
First Address | Caliente, NV 89008-9604 |
Second Address | Caliente, NV 89008-2242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2021 |
Last Update Date | 23/09/2021 |