MEDICARE: NNIKA DELADOMONE HANSERD

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1477809556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNIKA DELADOMONE HANSERD

Provider Business Mailing Address
First Line	:	3110 W CHEYENNE AVE
Second Line	:	SUITE 200A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2253
Country	:	US
Telephone Number	:	702-982-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 W CHEYENNE AVE
Second Line	:	SUITE 200A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2253
Country	:	US
Telephone Number	:	702-982-0600
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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Directions to “ NNIKA DELADOMONE HANSERD ” Practice Location

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