Basic Information
| Provider Information | |||||||||
| NPI: | 1255996146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITHERSPOON | ||||||||
| FirstName: | DRAONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8670 W CHEYENNE AVE STE 135 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891297460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028222600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8670 W CHEYENNE AVE STE 135 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891297460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028222600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | Y | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.