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NPI Code Detail

MEDICARE: MICHELLE RENEE WYATT

MEDICARE: MICHELLE RENEE WYATT
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
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1386949402
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE RENEE WYATT
Provider Business Mailing Address
First Line : 5304 DAYWOOD ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-7917
Country : US
Telephone Number : 702-649-5995
Fax Number : 702-399-9801
Provider Business Practice Location Address
First Line : 5304 DAYWOOD ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-7917
Country : US
Telephone Number : 702-649-5995
Fax Number : 702-399-9801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2011
Last Update Date : 09/21/2011

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Directions to “ MICHELLE RENEE WYATT ” Practice Location

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