Individual
NYLASIA PACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6360 S PECOS RD, SUITE 4, LAS VEGAS, NV 89120-3296
(702) 816-3400
Mailing address
650 E AZURE AVE APT 3088, NORTH LAS VEGAS, NV 89081-6882
(702) 917-9782
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1403364680
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1403364680
—
NV
Enumeration date
04/02/2013
Last updated
06/18/2013
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