Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023500147 |
---|---|
Provider Name | Pamela Dafney |
First Address | Las Vegas, NV 89130-3196 |
Second Address | Las Vegas, NV 89130-3196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 16/10/2019 |