MEDICARE: DEANNA CAMILLE FAUCETT

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	251B00000X	Case Management Agency	NV20191058990	NV

General Provider Information

NPI Number	:	1902360373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA CAMILLE FAUCETT

Provider Business Mailing Address
First Line	:	6816 WHITE SANDS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5334
Country	:	US
Telephone Number	:	702-238-3037
Fax Number	:	702-363-6756

Provider Business Practice Location Address
First Line	:	6816 WHITE SANDS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5334
Country	:	US
Telephone Number	:	702-238-3037
Fax Number	:	702-363-6756

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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Directions to “ DEANNA CAMILLE FAUCETT ” Practice Location

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