Individual
SID CHRISTIAN KEOMANIVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2677 BEALL LN, CENTRAL POINT, OR 97502-1462
(702) 343-0466
Mailing address
3344 WINTERHAVEN ST, UNIT 101, LAS VEGAS, NV 89108-5064
(702) 343-0466
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
201806379NP-PP
OR
Other
Enumeration date
08/03/2018
Last updated
10/08/2019
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