MEDICARE: MS. VENUS M GLASS

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	106S00000X	Behavior Technician
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1518244995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VENUS M GLASS

Provider Business Mailing Address
First Line	:	3305 E ROME BLVD APT 1100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1503
Country	:	US
Telephone Number	:	702-810-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 RANCH HOUSE RD UNIT 140
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4605
Country	:	US
Telephone Number	:	702-561-9157
Fax Number	:

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

Provider Enumeration Date	:	11/13/2011
Last Update Date	:	01/12/2021

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Directions to “ MS. VENUS M GLASS ” Practice Location

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