MEDICARE: NICOLEELAN

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750788014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLEELAN

Provider Business Mailing Address
First Line	:	8610 S MARYLAND PKWY
Second Line	:	1034
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2709
Country	:	US
Telephone Number	:	702-807-3614
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 S MARYLAND PKWY
Second Line	:	1034
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2709
Country	:	US
Telephone Number	:	702-807-3614
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. NICOLE ELAN FINKLEA
Credential	:
Telephone Number	:	702-807-3614

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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Directions to “NICOLEELAN ” Practice Location

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