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NPI Code Detail

MEDICARE: STATE OF NEVADA

MEDICARE: STATE OF NEVADA
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
1251B00000XCase Management Agency
2252Y00000XEarly Intervention Provider Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396831152
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF NEVADA
Provider Business Mailing Address
First Line : 1161 S VALLEY VIEW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1854
Country : US
Telephone Number : 702-486-7670
Fax Number :
Provider Business Practice Location Address
First Line : 1161 S VALLEY VIEW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1854
Country : US
Telephone Number : 702-486-7670
Fax Number :
Authorized Official
Title or Position : BUREAU CHIEF
Name : MS. JANELLE MULVENON
Credential :
Telephone Number : 775-684-3461
Provider Enumeration Date : 10/05/2006
Last Update Date : 06/20/2008

Similar Medicare Providers

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1528181260 — MRS. AMANDA K ROGERS M.S., CCC-SLP
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1861619389 — MRS. ANGELIQUE CASSANDRA GOLDEN MS, CCC-SLP
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Practice Fax:
1346458858 — TATIANA CLARKE M.S., CCC-SLP
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1750525283 — BELINDA MINARCHAN MS CCC-SLP
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Practice Fax:
1710112040 — TIFFANIE MARIE GASPAR MPT
Practice Location Address:
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Directions to “STATE OF NEVADA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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