Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023303104 |
---|---|
Provider Name | Jennie Inguanzo |
First Address | Las Vegas, NV 89117-2697 |
Second Address | Las Vegas, NV 89117-2697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 10/02/2022 |