Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1003329368 |
---|---|
Provider Name | Ms. Renae Simms |
First Address | Las Vegas, NV 89146-1013 |
Second Address | Las Vegas, NV 89146-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2017 |
Last Update Date | 04/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225400000X | (05) | NV |