Healthcare Provider Details

I. General information

NPI: 1023518123
Provider Name (Legal Business Name): MS. STARLEANA BRYANNE BAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 NORTH MARTIN LUTHER KING BLVD STE 211
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

3925 NORTH MARTIN LUTHER KING BLVD STE 211
NORTH LAS VEGAS NV
89032
US

V. Phone/Fax

Practice location:
  • Phone: 702-488-2284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: