Healthcare Provider Details

I. General information

NPI: 1114850955
Provider Name (Legal Business Name): LUCRESHA MONIA CHENEVERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 S MARYLAND PKWY STE 1
LAS VEGAS NV
89104-3106
US

IV. Provider business mailing address

2001 RAMROD AVE APT 1721
HENDERSON NV
89014-2387
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-3650
  • Fax:
Mailing address:
  • Phone: 725-292-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: