Basic Information
| Provider Information | |||||||||
| NPI: | 1790143832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEADHAM | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | ALANAH | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7360 EASTGATE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890114080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646072374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6600 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891469001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2016 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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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 | 225400000X | 1790143832 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.