Individual
MAVERENE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3210 W CHARLESTON BLVD STE 2, LAS VEGAS, NV 89102
(702) 893-2001
Mailing address
3210 W CHARLESTON BLVD STE 2, LAS VEGAS, NV 89102
(702) 893-2001
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111111111111111
—
NV
Enumeration date
07/05/2022
Last updated
07/05/2022
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