MEDICARE: ALLISON M DUBE LPN

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	164W00000X	Licensed Practical Nurse	851508	NV

General Provider Information

NPI Number	:	1457188013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON M DUBE LPN

Provider Business Mailing Address
First Line	:	3604 KINGFISHERS CATCH AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2347
Country	:	US
Telephone Number	:	978-979-5135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3604 KINGFISHERS CATCH AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2347
Country	:	US
Telephone Number	:	978-979-5135
Fax Number	:

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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