Healthcare Provider Details

I. General information

NPI: 1720800162
Provider Name (Legal Business Name): FAITH ELISABETH DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W CHEYENNE
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

1810 FIGHTING FALCON LANE
NORTH LAS VEGAS NV
89031
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-6314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: