MEDICARE: MAGNOLIA DALAN

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	3747P1801X	Personal Care Attendant		NV

General Provider Information

NPI Number	:	1811312424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGNOLIA DALAN

Provider Business Mailing Address
First Line	:	340 E WARM SPRINGS RD
Second Line	:	SUITE 4B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4257
Country	:	US
Telephone Number	:	702-476-8809
Fax Number	:	702-476-8633

Provider Business Practice Location Address
First Line	:	340 E WARM SPRINGS RD
Second Line	:	SUITE 4B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4257
Country	:	US
Telephone Number	:	702-476-8809
Fax Number	:	702-476-8633

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

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	02/19/2014

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Directions to “ MAGNOLIA DALAN ” Practice Location

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