Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ASIA MARIE BIENIEMY (BASIC SKILLS TRAINER)
(702) 979-0224
Entity
Organization
Contact information
Practice address
3370 SAINT ROSE PKWY APT 1428, HENDERSON, NV 89052-4254
(702) 979-0224
Mailing address
400 S 4TH ST STE 501, LAS VEGAS, NV 89101-6201
(702) 979-0224
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153499876
—
NV
Enumeration date
05/09/2016
Last updated
05/09/2016
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