Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0000082665 | NV |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043514524 |
---|---|
Provider Name | Rae Jonette Melson |
First Address | Las Vegas, NV 89119-6191 |
Second Address | Las Vegas, NV 89119-6191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 31/03/2011 |