MEDICARE: A'NIAH DEXTER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1922371806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	A'NIAH DEXTER

Provider Business Mailing Address
First Line	:	4435 MATINEE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0417
Country	:	US
Telephone Number	:	702-205-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	4435 MATINEE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0417
Country	:	US
Telephone Number	:	702-205-3944
Fax Number	:

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

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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Directions to “ A'NIAH DEXTER ” Practice Location

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