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NPI Code Detail

MEDICARE: MARILYN MESSMORE CNS

MEDICARE:   MARILYN  MESSMORE  CNS
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
1133N00000XNutritionist

General Provider Information

NPI Number : 1710567268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN MESSMORE CNS
Provider Business Mailing Address
First Line : 10415 ABISSO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-2572
Country : US
Telephone Number : 702-716-2098
Fax Number :
Provider Business Practice Location Address
First Line : 10415 ABISSO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-2572
Country : US
Telephone Number : 702-716-2098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2021
Last Update Date : 04/09/2021

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