Basic Information
| Provider Information | |||||||||
| NPI: | 1700387446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARK | ||||||||
| FirstName: | MAPLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9199 FEATHER STREAM CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891232998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024999324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 E DESERT INN RD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891693242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028391088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2018 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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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 | 251E00000X | Y | Agencies | Home Health |
No ID Information.