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General NPI Number Information
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NPI Number | 1295561470
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Entity Type | Individual
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Provider Name | WILBUR LASANE JR. CPT
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Gender | Male
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1931 GIANT PINE AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-5071
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Country | US
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Telephone | 725-200-0821
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Fax | 702-710-9972
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Provider Business Mailing Address
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Address Line | 1931 GIANT PINE AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-5071
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Country | US
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Telephone | 725-200-0821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 1241242665
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License Number State | NV
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