Healthcare Provider Details

I. General information

NPI: 1821401795
Provider Name (Legal Business Name): MS. CHARLOTTE YVETTE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CHARLOTTE YVETTE BROWNE

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 06/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 URIBE ST
LAS VEGAS NV
89129-6133
US

IV. Provider business mailing address

3340 URIBE ST
LAS VEGAS NV
89129-6133
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-8102
  • Fax: 702-233-8102
Mailing address:
  • Phone: 702-233-8102
  • Fax: 702-233-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number1404614856
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: