Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033497342 |
---|---|
Provider Name | Darnesha Moniece Martin |
First Address | N Las Vegas, NV 89032-8228 |
Second Address | N Las Vegas, NV 89032-8228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 03/08/2011 |