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Contact Information

PROVENANCE HEALTHCARE LLC
5155 S DURANGO DR STE 103
LAS VEGAS, NV89113-0175
 Phone: 702-478-2524
 Fax: 702-735-9074
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Genetic Counselor, MS

170300000X
Indicates primary specialty

NPI Profile & details for PROVENANCE HEALTHCARE LLC · (Female)

NPI # 1316322738
Status Active
Credentials
Entity Individual
Enumeration date 07/27/2015
Last updated 07/27/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • NV License # OTHER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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