| NPI | 1902679103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA A CHACHERE Billing Credentialing Specialist 702-502-7254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-10-31 |