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General NPI Number Information
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NPI Number | 1740548437
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Entity Type | Organization
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Legal Business Name | TRANSFORMING 2 GREATNESS
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 2616 SLIDE CANYON AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89081-6411
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Country | US
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Telephone | 702-501-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 SLIDE CANYON AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89081-6411
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Country | US
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Telephone | 702-501-8633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE DENISE BROWN
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Credential |
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Telephone | 702-301-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | NV20121134253
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License Number State | NV
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