Healthcare Provider Details

I. General information

NPI: 1396355848
Provider Name (Legal Business Name): MISS STEPHANEY M ROUNDTREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 MOUNT HOOD ST
LAS VEGAS NV
89156-7049
US

IV. Provider business mailing address

1795 MOUNT HOOD ST
LAS VEGAS NV
89156-7049
US

V. Phone/Fax

Practice location:
  • Phone: 702-913-0770
  • Fax:
Mailing address:
  • Phone: 702-913-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number2851742
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: