Healthcare Provider Details

I. General information

NPI: 1104227487
Provider Name (Legal Business Name): DEBORAH HOOTSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 SENECA HIGHLAND
NORTH LAS VEGAS NV
89032-0494
US

IV. Provider business mailing address

P.O. BOX 571445
LAS VEGAS NV
89157
US

V. Phone/Fax

Practice location:
  • Phone: 702-827-8080
  • Fax: 702-648-2109
Mailing address:
  • Phone: 702-827-8080
  • Fax: 702-648-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: