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NPI Code Detail

MEDICARE: DAESHAWN ANTHONY NIXON

MEDICARE: DAESHAWN ANTHONY NIXON
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1922449503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAESHAWN ANTHONY NIXON
Provider Business Mailing Address
First Line : 3636 LAS VEGAS BLVD N
Second Line : SUITE B
City : LAS VEGAS
State : NV
Zip : 89115-1555
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3636 LAS VEGAS BLVD N
Second Line : SUITE B
City : LAS VEGAS
State : NV
Zip : 89115-1555
Country : US
Telephone Number : 702-776-8397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2013
Last Update Date : 07/11/2013

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Directions to “ DAESHAWN ANTHONY NIXON ” Practice Location

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