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NPI Code Detail

MEDICARE: WINONA PRESTON

MEDICARE: WINONA PRESTON
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1588009831
Entity Type Code : Individual
Provider Name (Legal Business Name) : WINONA PRESTON
Provider Business Mailing Address
First Line : 3851 WYNN RD APT 1113
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-6018
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3925 W CHEYENNE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-3494
Country : US
Telephone Number : 702-868-2905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2013
Last Update Date : 04/30/2013

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Directions to “ WINONA PRESTON ” Practice Location

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