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General NPI Number Information
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NPI Number | 1235881699
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Entity Type | Organization
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Legal Business Name | NIKKI LACE & CO LLC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 6835 W CHARLESTON BLVD # 102
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City | LAS VEGAS
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State | NV
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Zip | 89117-1635
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Country | US
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Telephone | 702-498-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 2556
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone | 702-498-5606
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXANDRA LEE
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Credential |
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Telephone | 702-497-5606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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