Healthcare Provider Details

I. General information

NPI: 1902597164
Provider Name (Legal Business Name): REBECCA S BRYANT LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR STE H51
LAS VEGAS NV
89106-4836
US

IV. Provider business mailing address

501 S RANCHO DR STE H51
LAS VEGAS NV
89106-4836
US

V. Phone/Fax

Practice location:
  • Phone: 701-461-1879
  • Fax:
Mailing address:
  • Phone: 701-461-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberE46
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: