Individual
RANIQUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8430 W LAKE MEAD BLVD STE 100, LAS VEGAS, NV 89128-7674
(702) 576-9893
Mailing address
8430 W LAKE MEAD BLVD STE 100, LAS VEGAS, NV 89128-7674
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
NV
Enumeration date
06/19/2017
Last updated
06/19/2017
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