Individual
STACEY DOMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6767 W TROPICANA AVE STE 100, LAS VEGAS, NV 89103-4755
(170) 220-9037
Mailing address
6767 W TROPICANA AVE STE 100, LAS VEGAS, NV 89103-4755
(702) 209-0370
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/24/2021
Last updated
05/24/2021
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