Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1154811883 |
---|---|
Provider Name | Denise L Fairley |
First Address | Las Vegas, NV 89147-6831 |
Second Address | Las Vegas, NV 89147-6831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |