Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1619458098 |
---|---|
Provider Name | Tamara Runnicles |
First Address | Henderson, NV 89014-6825 |
Second Address | Las Vegas, NV 89117-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |