Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 225400000X | NV |
NPI | 1558610907 |
---|---|
Provider Name | Glynnese Coleman |
First Address | N Las Vegas, NV 89084-2087 |
Second Address | N Las Vegas, NV 89084-2087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 30/08/2012 |