Individual
DONDRE AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10446 MIDSEASON MIST ST, LAS VEGAS, NV 89183-4299
(702) 538-6633
Mailing address
10446 MIDSEASON MIST ST, LAS VEGAS, NV 89183-4299
(702) 538-6633
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
844898407
—
NV
Enumeration date
11/22/2011
Last updated
06/18/2020
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