Healthcare Provider Details

I. General information

NPI: 1043695521
Provider Name (Legal Business Name): MADYSON WIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADYSON RUSHING

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12231 S EASTERN AVE STE 140
HENDERSON NV
89052
US

IV. Provider business mailing address

290 SUTTON HILLS PL
HENDERSON NV
89002-9745
US

V. Phone/Fax

Practice location:
  • Phone: 702-376-2838
  • Fax:
Mailing address:
  • Phone: 702-376-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: