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NPI Code Detail

MEDICARE: SIERRA IVERSON

MEDICARE: SIERRA IVERSON
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
1106S00000XBehavior TechnicianRBT-22-217058NV

General Provider Information

NPI Number : 1609515386
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIERRA IVERSON
Provider Business Mailing Address
First Line : 7260 W AZURE DR STE 140-104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-7999
Country : US
Telephone Number : 702-848-2980
Fax Number : 844-440-1834
Provider Business Practice Location Address
First Line : 7570 NORMAN ROCKWELL LN STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89143-6013
Country : US
Telephone Number : 702-848-2980
Fax Number : 844-440-1834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2022
Last Update Date : 06/01/2022

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Directions to “ SIERRA IVERSON ” Practice Location

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