Individual
EBONY COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 W PACIFIC AVE, HENDERSON, NV 89015-7376
(702) 565-1020
(702) 565-1035
Mailing address
204 W PACIFIC AVE, HENDERSON, NV 89015-7376
(702) 565-1020
(702) 565-1035
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
1605073477
NV
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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