Healthcare Provider Details

I. General information

NPI: 1265666788
Provider Name (Legal Business Name): KAROLYN L WITCHER R. EEG T, CNIM, CLTM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W CHARLESTON BLVD SUITE H77
LAS VEGAS NV
89102-1921
US

IV. Provider business mailing address

8550 W CHARLESTON BLVD #102-171
LAS VEGAS NV
89117-9210
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-3315
  • Fax: 702-583-7920
Mailing address:
  • Phone: 702-258-3315
  • Fax: 702-583-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: