Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043569700 |
---|---|
Provider Name | Taresa Lavonne Frazier |
First Address | Las Vegas, NV 89156-4797 |
Second Address | Las Vegas, NV 89156-4797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2012 |
Last Update Date | 14/06/2019 |