NPI 1316322738

Provenance Healthcare LLC

Organisation Genetic Counselor (M.S.) Las Vegas, NV

Practice location

Address: 5155 S Durango Dr STE 103, Las Vegas, NV 89113-0175
Phone: (702) 478-2524
Fax: (702) 735-9074

Authorised official

Name: Mark L Black
Title: Owner Operator
Phone: (702) 478-2524

Registered specialties

Genetic Counselor (M.S.) Primary

Other Service Providers Taxonomy 170300000X Licence OTHER (NV)

Other Genetic Counselor, MS providers in Nevada →

Registry record

NPI: 1316322738
Entity type: Organization
NPI issued: 27 Jul 2015
Record last updated: 27 Jul 2015

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.