Individual
EBONY CHEYENNE SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2560 MONTESSOURI ST STE 207, LAS VEGAS, NV 89117-3064
(702) 478-8400
Mailing address
2560 MONTESSOURI ST STE 207, LAS VEGAS, NV 89117-3064
(702) 478-8400
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82
AMERIGROUP
NV
05
—
82
—
NV
Enumeration date
02/09/2013
Last updated
02/09/2013
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