Mr. Jerrell De'andre Roberts
Rehabilitation Practitioner
2704 Prospector Mine Ave
North Las Vegas
, Nevada 89031-1188
Mr. Jerrell De'andre Roberts
Rehabilitation Practitioner
2704 Prospector Mine Ave
North Las Vegas
, Nevada 89031-1188
(702) 647-5300
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About
Features
Specialties
- Rehabilitation Practitioner
Languages spoken
- English
Location
First Address
- Mr. Jerrell De'andre Roberts
- 2704 Prospector Mine Ave
- North Las Vegas, NV
- Zip : 89031-1188
- Phone : (702) 647-5300
Second Address
- Mr. Jerrell De'andre Roberts
- 2704 Prospector Mine Ave
- North Las Vegas, NV
- Zip : 89031-1188
- Phone : (702) 647-5300
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Is Mr. Jerrell De'andre Roberts a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225400000X | Rehabilitation Practitioner | NV |
National Provider Identifier
| NPI | 1003195488 |
|---|---|
| Provider Name | Mr. Jerrell De'andre Roberts |
| First Address | North Las Vegas, NV 89031-1188 |
| Second Address | North Las Vegas, NV 89031-1188 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/08/2011 |
| Last Update Date | 16/09/2011 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.