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NPI Code Detail

MEDICARE: MAURICE WINDHAM

MEDICARE: MAURICE WINDHAM
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1417250531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURICE WINDHAM
Provider Business Mailing Address
First Line : 3900 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1682
Country : US
Telephone Number : 702-453-4673
Fax Number :
Provider Business Practice Location Address
First Line : 3900 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1682
Country : US
Telephone Number : 702-453-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2010
Last Update Date : 12/10/2010

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Directions to “ MAURICE WINDHAM ” Practice Location

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