Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053879262 |
---|---|
Provider Name | Mrs. Judith Carol Baron |
First Address | Henderson, NV 89015-7376 |
Second Address | Henderson, NV 89015-7376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 06/03/2019 |