Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 225400000X | NV |
NPI | 1003115643 |
---|---|
Provider Name | Shana Quinn Bachus |
First Address | Las Vegas, NV 89126-1794 |
Second Address | Las Vegas, NV 89119-6263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 22/03/2011 |