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NPI Code Detail

MEDICARE: AMANDA LEE PEARSON MS

MEDICARE: AMANDA LEE PEARSON MS
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
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator
3225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1417251075
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEE PEARSON MS
Provider Business Mailing Address
First Line : 5659 DUNCAN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2811
Country : US
Telephone Number : 435-201-9683
Fax Number :
Provider Business Practice Location Address
First Line : 5659 DUNCAN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2811
Country : US
Telephone Number : 435-201-9683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2010
Last Update Date : 07/25/2013

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