Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | NV |
NPI | 1003366642 |
---|---|
Provider Name | Peggy Colvin |
First Address | Las Vegas, NV 89130-2536 |
Second Address | Las Vegas, NV 89130-2536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
472415904 | (05) | NV |