Individual
HA T LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 E CALVADA BLVD, PAHRUMP, NV 89048-5807
(775) 727-5509
(775) 727-5696
Mailing address
PO BOX 98978, LAS VEGAS, NV 89193-8978
(702) 507-2419
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1107
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144491143
—
NV
01
—
P00872897
RAILROAD MEDICARE
NV
Enumeration date
03/18/2008
Last updated
01/25/2012
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