Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1285972034 |
---|---|
Provider Name | Denicia Powell |
First Address | N Las Vegas, NV 89031-6627 |
Second Address | N Las Vegas, NV 89032-7676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 29/01/2013 |