Healthcare Provider Details

I. General information

NPI: 1366995664
Provider Name (Legal Business Name): DENISE PETERS-BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY STE 9A
HENDERSON NV
89074
US

IV. Provider business mailing address

2717 HERITAGE DR
LAS VEGAS NV
89121-1405
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-1100
  • Fax:
Mailing address:
  • Phone: 702-793-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: