MEDICARE: MAKHALA VINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	3747P1801X	Personal Care Attendant
3	372500000X	Chore Provider

General Provider Information

NPI Number	:	1891387056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKHALA VINSON

Provider Business Mailing Address
First Line	:	604 ALEXANDER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2617
Country	:	US
Telephone Number	:	702-412-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 E FLAMINGO RD APT 322
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7443
Country	:	US
Telephone Number	:	702-955-0267
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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Directions to “ MAKHALA VINSON ” Practice Location

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