Individual
CHAMPAGNE SUMBRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QBA
Contact information
Practice address
8670 W CHEYENNE AVE STE 120, LAS VEGAS, NV 89129-7457
(702) 419-1262
Mailing address
801 DESERT OAK CT APT C, LAS VEGAS, NV 89145-2464
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/07/2017
Last updated
12/07/2017
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