Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C-43751 | NV |
NPI | 1235794595 |
---|---|
Provider Name | Marquise D Dennis |
First Address | Las Vegas, NV 89139-0506 |
Second Address | Henderson, NV 89014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2019 |
Last Update Date | 02/05/2019 |