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General NPI Number Information
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NPI Number | 1891502308
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Entity Type | Individual
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Provider Name | MICHELLE MARATAS WEBB CHW1
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2915 W CHARLESTON BLVD STE 190
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City | LAS VEGAS
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State | NV
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Zip | 89102-1978
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Country | US
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Telephone | 626-598-6748
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 W CHARLESTON BLVD # 170-487
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City | LAS VEGAS
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State | NV
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Zip | 89135-1573
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Country | US
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Telephone | 562-394-3746
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | CHW1-5965
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License Number State | NV
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