Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1518335678 |
---|---|
Provider Name | Marie Irving |
First Address | Las Vegas, NV 89107-3386 |
Second Address | Las Vegas, NV 89107-3386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2015 |
Last Update Date | 07/09/2015 |