Basic Information
| Provider Information | |||||||||
| NPI: | 1639687221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARD | ||||||||
| FirstName: | SHAVON | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4375 BOULDER HWY STE 283 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891213077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027040433 | ||||||||
| FaxNumber: | 7022933664 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N RAINBOW BLVD STE 212 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891071189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027040433 | ||||||||
| FaxNumber: | 7022933664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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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.