Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023372844 |
---|---|
Provider Name | Mrs. Tiffany Bearden |
First Address | Las Vegas, NV 89136-1581 |
Second Address | Las Vegas, NV 89146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 28/04/2014 |