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NPI Code Detail

MEDICARE: STACY BLESER

MEDICARE:   STACY  BLESER
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1396080479
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY BLESER
Provider Business Mailing Address
First Line : 1580 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-2548
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1580 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-2548
Country : US
Telephone Number : 702-836-3442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2012
Last Update Date : 11/30/2012

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Directions to “ STACY BLESER ” Practice Location

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