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Organization

LIFE BREAKTHROUGH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LESLIE KALYN DNP (PRESIDENT)
(702) 895-1883
Entity
Organization

Contact information

Practice address
10885 S EASTERN AVE, HENDERSON, NV 89052-5857
(702) 895-1883
Mailing address
11740 VILLA MALAPARTE AVE, LAS VEGAS, NV 89138-6013
(702) 895-1883

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN001086
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
APRN001086
APRN LICENSE
NV
Enumeration date
09/16/2017
Last updated
09/16/2017
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