Basic Information
| Provider Information | |||||||||
| NPI: | 1528545431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERINE | ||||||||
| FirstName: | CHRISSANDRA | ||||||||
| MiddleName: | DIONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3151 SOARING GULLS DR UNIT 2099 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891287040 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1536 N BOULDER HWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890114120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025588600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2018 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN15454 | NV | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.