Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1710260559 |
---|---|
Provider Name | Jennifer Militello |
First Address | Las Vegas, NV 89130-3455 |
Second Address | Las Vegas, NV 89130-3455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 14/03/2013 |