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NPI Code Detail

MEDICARE: MRS. WILMA CARTER GAINES

MEDICARE: MRS. WILMA CARTER GAINES
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
1225400000XRehabilitation Practitioner
23747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1790021871
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WILMA CARTER GAINES
Provider Business Mailing Address
First Line : 2205 SPANISH TOWN AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031
Country : US
Telephone Number : 702-658-9563
Fax Number :
Provider Business Practice Location Address
First Line : 1701 N GREEN VALLEY PKWY STE 9A
Second Line :
City : HENDERSON
State : NV
Zip : 89074-5991
Country : US
Telephone Number : 702-407-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2012
Last Update Date : 04/29/2019

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Directions to “ MRS. WILMA CARTER GAINES ” Practice Location

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