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General NPI Number Information
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NPI Number | 1912482902
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Entity Type | Individual
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Provider Name | MACKENZIE GALLAGHER SMITH
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 9811 W CHARLESTON BLVD # 2-641
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone | 855-864-4322
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Fax |
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Provider Business Mailing Address
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Address Line | 1854 TIMBER GLADE PL
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-1100
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Country | US
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Telephone | 702-401-3418
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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 | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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License Number State |
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