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NPI Code Detail

MEDICARE: ANITRA EGNOR

MEDICARE: ANITRA EGNOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2103K00000XBehavior Analyst
3251B00000XCase Management Agency
4347C00000XPrivate Vehicle

General Provider Information

NPI Number : 1083086458
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITRA EGNOR
Provider Business Mailing Address
First Line : 5157 COMIDA LN
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89031-3318
Country : US
Telephone Number : 702-239-1989
Fax Number : 702-464-5081
Provider Business Practice Location Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number : 702-464-5080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2015
Last Update Date : 10/26/2015

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Directions to “ ANITRA EGNOR ” Practice Location

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