Healthcare Provider Details

I. General information

NPI: 1730510355
Provider Name (Legal Business Name): ADRINE DUNCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 12/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 ROSE CANYON DR
NORTH LAS VEGAS NV
89032-7864
US

IV. Provider business mailing address

3515 ROSE CANYON DR
NORTH LAS VEGAS NV
89032-7864
US

V. Phone/Fax

Practice location:
  • Phone: 702-306-4672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: