Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043597917 |
---|---|
Provider Name | Stephanie Bandics |
First Address | Henderson, NV 89002-9644 |
Second Address | Henderson, NV 89002-9644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2011 |
Last Update Date | 07/11/2011 |