Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1101X | Ophthalmic Assistant | NV |
NPI | 1538638507 |
---|---|
Provider Name | Sally Harris |
First Address | Pahrump, NV 89048-5041 |
Second Address | North Las Vegas, NV 89030-4773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 19/11/2018 |