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NPI Code Detail

MEDICARE: DONNA E UPCHURCH

MEDICARE: DONNA E UPCHURCH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1306326046
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA E UPCHURCH
Provider Business Mailing Address
First Line : 4325 W ROME BLVD APT 1179
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-5409
Country : US
Telephone Number : 702-280-3082
Fax Number :
Provider Business Practice Location Address
First Line : 4325 W ROME BLVD APT 1179
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-5409
Country : US
Telephone Number : 702-280-3082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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Directions to “ DONNA E UPCHURCH ” Practice Location

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