Healthcare Provider Details

I. General information

NPI: 1558883488
Provider Name (Legal Business Name): SARAH BLANCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 PECOS-MCLEOD STE 103
LAS VEGAS NV
89121
US

IV. Provider business mailing address

3737 PECOS MCLEOD STE 103
LAS VEGAS NV
89121-4263
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-3038
  • Fax:
Mailing address:
  • Phone: 702-433-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-17590
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: