Individual
MRS. JANUARY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1013 STONEYPEAK AVE, N LAS VEGAS, NV 89081-3239
(702) 478-5252
Mailing address
2608 WOOLY ROSE AVE, LAS VEGAS, NV 89106-1466
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
5002AGC-12
NV
Other
Enumeration date
09/11/2014
Last updated
09/15/2014
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