Healthcare Provider Details

I. General information

NPI: 1851934178
Provider Name (Legal Business Name): KATRINA IRENE BUHNEING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W PACIFIC AVE
HENDERSON NV
89015-7376
US

IV. Provider business mailing address

204 W PACIFIC AVE
HENDERSON NV
89015-7376
US

V. Phone/Fax

Practice location:
  • Phone: 702-857-5019
  • Fax:
Mailing address:
  • Phone: 702-857-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: