Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023452356 |
---|---|
Provider Name | Doniele Nicole Johnston |
First Address | Las Vegas, NV 89121-5027 |
Second Address | Las Vegas, NV 89121-5027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 17/04/2013 |