Organization
MAPLE STAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIDRA ELYCE MARS (SKILLS REHABILITATION WORKER)
(775) 287-4208
Entity
Organization
Contact information
Practice address
4773 CAUGHLIN PKWY, SUITE 2, RENO, NV 89519-1011
(775) 297-4208
Mailing address
4773 CAUGHLIN PKWY, SUITE 2, RENO, NV 89519-1011
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
880321776
—
NV
Enumeration date
07/10/2013
Last updated
08/19/2013
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