Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013544089 |
---|---|
Provider Name | Monique Shivers-Guevara |
First Address | Las Vegas, NV 89101-3429 |
Second Address | Las Vegas, NV 89120-1299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |