MEDICARE: MICHELLE P FANNING

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1326387853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE P FANNING

Provider Business Mailing Address
First Line	:	2820 W. CHARLESTON BLVD
Second Line	:	C23
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-564-6538
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 W. CHARLESTON BOULEVARD
Second Line	:	C23
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-437-4673
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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Directions to “ MICHELLE P FANNING ” Practice Location

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