Individual
CALANDRA TAHNEE BROADES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5067 MADRE MESA DR APT 2015, LAS VEGAS, NV 89108-3592
(903) 280-5025
Mailing address
5067 MADRE MESA DR APT 2015, LAS VEGAS, NV 89108-3592
(903) 280-5025
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NV2022642425
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
884365835
—
NV
Enumeration date
01/02/2023
Last updated
01/02/2023
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