MEDICARE: MRS. MARVA ELANE BURR

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326482498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARVA ELANE BURR

Provider Business Mailing Address
First Line	:	6440 SKY POINTE DR
Second Line	:	SUITE 140-162
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4047
Country	:	US
Telephone Number	:	702-489-4596
Fax Number	:	702-489-4835

Provider Business Practice Location Address
First Line	:	6624 SKY POINTE DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-489-4835
Fax Number	:	702-489-4835

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

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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