Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003166604 |
---|---|
Provider Name | Jamelle Berry |
First Address | Las Vegas, NV 89128-0804 |
Second Address | Las Vegas, NV 89128-0804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 01/06/2020 |