Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1245522499 |
---|---|
Provider Name | Shane Monjar |
First Address | Reno, NV 89512-1666 |
Second Address | Reno, NV 89512-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 08/02/2014 |