Healthcare Provider Details

I. General information

NPI: 1346530425
Provider Name (Legal Business Name): JAMIE LEE CICHON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

4270 S DECATUR BLVD STE B6
LAS VEGAS NV
89103-6802
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-2100
  • Fax: 702-825-0091
Mailing address:
  • Phone: 702-485-2100
  • Fax: 702-825-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17046
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10376858-8905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: