Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1033519384 |
---|---|
Provider Name | Tiffany Lynn Dickinson |
First Address | Spring Creek, NV 89815-6157 |
Second Address | Las Vegas, NV 89119-4687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2014 |
Last Update Date | 22/08/2014 |