NPI 1114373156

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Organisation Exclusive Provider Organization Henderson, NV

Practice location

Address: 3370 Saint Rose Pkwy APT 1428, Henderson, NV 89052-4254
Phone: (702) 979-0224
Mailing address: 400 S 4th St STE 501, Las Vegas, NV 89101-6201

Authorised official

Name: Asia Marie Bieniemy
Title: Basic Skills Trainer
Phone: (702) 979-0224

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1114373156
Entity type: Organization
NPI issued: 9 May 2016
Record last updated: 9 May 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.