Individual
TABITHA R FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRANIAL PROSTHESIS
Contact information
Practice address
5710 SIMMONS ST # A1, NORTH LAS VEGAS, NV 89031-9900
(323) 921-5084
Mailing address
410 HORSE POINTE AVE, NORTH LAS VEGAS, NV 89084-1225
(323) 921-5084
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/03/2025
Last updated
02/03/2025
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