Healthcare Provider Details

I. General information

NPI: 1760022859
Provider Name (Legal Business Name): WHITNEY MCINTYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 VEGAS DR
LAS VEGAS NV
89108-2403
US

IV. Provider business mailing address

395 N 16TH ST
LAS VEGAS NV
89101-4176
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax:
Mailing address:
  • Phone: 775-835-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberIC-1990
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: