Healthcare Provider Details

I. General information

NPI: 1104221464
Provider Name (Legal Business Name): MS. MELISSA M FERRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 E RUSSELL RD
LAS VEGAS NV
89120-2426
US

IV. Provider business mailing address

1217 WOODMORE ST
LAS VEGAS NV
89144-1131
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-5919
  • Fax: 702-483-5546
Mailing address:
  • Phone: 206-909-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: