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NPI Code Detail

MEDICARE: MS. SONYA RENAE JACKSON HUDDLESTON

MEDICARE: MS. SONYA RENAE JACKSON HUDDLESTON
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1154813400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SONYA RENAE JACKSON HUDDLESTON
Provider Business Mailing Address
First Line : 2656 N BUFFALO DR UNIT 1306
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4812
Country : US
Telephone Number : 702-808-3041
Fax Number : 888-725-8902
Provider Business Practice Location Address
First Line : 2656 N BUFFALO DR UNIT 1306
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4812
Country : US
Telephone Number : 702-808-3041
Fax Number : 888-725-8902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2018
Last Update Date : 06/02/2018

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Directions to “ MS. SONYA RENAE JACKSON HUDDLESTON ” Practice Location

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