Healthcare Provider Details

I. General information

NPI: 1134906829
Provider Name (Legal Business Name): FATIMATA CISSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 E LAKE MEAD BLVD STE B111
LAS VEGAS NV
89115-6466
US

IV. Provider business mailing address

4080 E LAKE MEAD BLVD STE B111
LAS VEGAS NV
89115-6466
US

V. Phone/Fax

Practice location:
  • Phone: 702-531-9344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: