| NPI | 1790465698 |
|---|---|
| Doing Business As | THE VICE PRACTICE |
| Entity Type | Organization |
| Authorized Contact | SUSIE MIRELES Credentialing Specialist 702-630-5740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-11-15 |