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NPI Code Detail

MEDICARE: DENISE L FAIRLEY CERTIFIED NURSING AS

MEDICARE:   DENISE L FAIRLEY  CERTIFIED NURSING AS
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
1224P00000XProsthetist

General Provider Information

NPI Number : 1154811883
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE L FAIRLEY CERTIFIED NURSING AS
Provider Business Mailing Address
First Line : 3980 ASPIRATION CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6831
Country : US
Telephone Number : 702-843-9271
Fax Number :
Provider Business Practice Location Address
First Line : 3980 ASPIRATION CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6831
Country : US
Telephone Number : 702-843-9271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 05/17/2018

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Directions to “ DENISE L FAIRLEY CERTIFIED NURSING AS” Practice Location

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