Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023425212 |
---|---|
Provider Name | Ms. Carmelina Jimerson |
First Address | North Las Vegas, NV 89030-4002 |
Second Address | North Las Vegas, NV 89030-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2014 |
Last Update Date | 19/07/2014 |