=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710401385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ANNE KAPLAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2017
-----------------------------------------------------
Last Update Date | 07/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4760 PAHRUMP VALLEY BLVD STE 9
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048-1474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-816-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 BRUCE ST
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048-6667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-816-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | NV20171467634
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------