Individual
LATASHA NICOLE BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8430 W LAKE MEAD BLVD STE 114, LAS VEGAS, NV 89128-7672
(702) 576-9891
Mailing address
5509 BALZAR AVE, LAS VEGAS, NV 89108-3101
(702) 666-4830
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1603214099
—
NV
Enumeration date
09/07/2017
Last updated
08/07/2019
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