MEDICARE: DRESHAUNA GILL

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1497271324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRESHAUNA GILL

Provider Business Mailing Address
First Line	:	7082 ARCADIA GLEN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3161
Country	:	US
Telephone Number	:	702-787-3974
Fax Number	:

Provider Business Practice Location Address
First Line	:	7082 ARCADIA GLEN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3161
Country	:	US
Telephone Number	:	702-787-3974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/22/2017

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