Individual
KELLY ANN WADDILOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5412 BOULDER HWY, LAS VEGAS, NV 89122-6039
(702) 291-7121
(702) 507-2534
Mailing address
5340 DURALITE ST UNIT 203, LAS VEGAS, NV 89122-7300
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/23/2020
Last updated
10/23/2020
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