Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003429127 |
---|---|
Provider Name | Mykalla Hope Fielding |
First Address | Las Vegas, NV 89121-2077 |
Second Address | Las Vegas, NV 89119-5250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |