Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 5341-C | NV |
NPI | 1285049056 |
---|---|
Provider Name | Dorrian White |
First Address | North Las Vegas, NV 89084-5403 |
Second Address | North Las Vegas, NV 89084-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
272551403 | (05) | NV |