Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043785769 |
---|---|
Provider Name | Latrice Norsworthy |
First Address | North Las Vegas, NV 89031-3840 |
Second Address | North Las Vegas, NV 89081-4086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 09/10/2018 |