Individual
MR. ANTWINE HACKNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1217 GOLD AVE, LAS VEGAS, NV 89106-2809
(702) 324-3691
Mailing address
1217 GOLD AVE, LAS VEGAS, NV 89106-2809
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/16/2011
Last updated
07/16/2011
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