Healthcare Provider Details

I. General information

NPI: 1699001792
Provider Name (Legal Business Name): CHARITIE ANNE BRONSON B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 BIG HORN VIEW ST
NORTH LAS VEGAS NV
89031-6806
US

IV. Provider business mailing address

5916 BIG HORN VIEW ST
NORTH LAS VEGAS NV
89031-6806
US

V. Phone/Fax

Practice location:
  • Phone: 702-612-3716
  • Fax: 702-834-3544
Mailing address:
  • Phone: 702-612-3716
  • Fax: 702-834-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: