Individual
GWENDOLYN IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5412 BOULDER HWY, LAS VEGAS, NV 89122-6039
(702) 291-7121
Mailing address
9623 BIGHORN RANCH AVE, LAS VEGAS, NV 89148-4221
(773) 656-1525
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
812191
NV
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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