MEDICARE: DANA JANINE DUNCAN LABORATORY ASSISTANT

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	374700000X	Technician

General Provider Information

NPI Number	:	1821878844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA JANINE DUNCAN LABORATORY ASSISTANT

Provider Business Mailing Address
First Line	:	9000 LAS VEGAS BLVD S BLDG S
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3367
Country	:	US
Telephone Number	:	317-809-4536
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 LAS VEGAS BLVD S UNIT 1283
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3376
Country	:	US
Telephone Number	:	317-809-4536
Fax Number	:

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

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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