Individual
MS. SHANICE LATAE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
4024 SMOKEY FOG AVE UNIT 101, NORTH LAS VEGAS, NV 89081-3842
(760) 269-2482
Mailing address
4024 SMOKEY FOG AVE UNIT 101, NORTH LAS VEGAS, NV 89081-3842
(760) 269-2482
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
09/18/2012
Last updated
12/18/2024
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