Healthcare Provider Details

I. General information

NPI: 1437441805
Provider Name (Legal Business Name): MARJORIE ANNE DACKO CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E DESERT INN RD SUITE 100
LAS VEGAS NV
89169-3242
US

IV. Provider business mailing address

1700 E DESERT INN RD SUITE 100
LAS VEGAS NV
89169-3242
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-8533
  • Fax: 702-433-8533
Mailing address:
  • Phone: 702-433-8533
  • Fax: 702-433-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNMA601
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: