Basic Information
| Provider Information | |||||||||
| NPI: | 1063968600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | KATHRIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9499 W CHARLESTON BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029333600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9499 W CHARLESTON BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029333600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.