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NPI Code Detail

MEDICARE: NIKKI LACE & CO LLC

MEDICARE: NIKKI LACE & CO LLC
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
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1235881699
Entity Type Code : Organization
Provider Name (Legal Business Name) : NIKKI LACE & CO LLC
Provider Business Mailing Address
First Line : 304 S JONES BLVD # 2556
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2623
Country : US
Telephone Number : 702-498-5606
Fax Number :
Provider Business Practice Location Address
First Line : 6835 W CHARLESTON BLVD # 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1635
Country : US
Telephone Number : 702-498-5606
Fax Number :
Authorized Official
Title or Position : CEO
Name : ALEXANDRA LEE
Credential :
Telephone Number : 702-497-5606
Provider Enumeration Date : 01/26/2022
Last Update Date : 02/02/2022

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Directions to “NIKKI LACE & CO LLC ” Practice Location

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