Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043516156 |
---|---|
Provider Name | Jabari Everett |
First Address | N Las Vegas, NV 89081-6405 |
Second Address | N Las Vegas, NV 89081-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 07/02/2011 |