Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053686840 |
---|---|
Provider Name | Krystal Amanda Burns |
First Address | Pahrump, NV 89048-7445 |
Second Address | Pahrump, NV 89048-5399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2012 |
Last Update Date | 13/03/2012 |