MEDICARE: LEONA MCCUIN CERTIFICATE

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1548527674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONA MCCUIN CERTIFICATE

Provider Business Mailing Address
First Line	:	245 E CENTENNIAL PKWY
Second Line	:	3031
City	:	N. LAS VEGAS
State	:	NV
Zip	:	89084
Country	:	US
Telephone Number	:	702-376-5234
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 E CENTENNIAL PKWY
Second Line	:	3031
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-1354
Country	:	US
Telephone Number	:	702-376-5234
Fax Number	:

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

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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