MEDICARE: NICOL KANANI AIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist	MI0731	NV

General Provider Information

NPI Number	:	1023307709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOL KANANI AIU

Provider Business Mailing Address
First Line	:	4638 WHITE HEAD CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4746
Country	:	US
Telephone Number	:	808-368-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0842
Country	:	US
Telephone Number	:	702-629-6982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	06/22/2020

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