Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013214626 |
---|---|
Provider Name | Mrs. Shannon Janeen Duty Reeder |
First Address | Las Vegas, NV 89139 |
Second Address | Las Vegas, NV 89130-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 14/03/2011 |