Most Relevant Information
Provider Data
| NPI Number: | 1003476391 |
| Provider Name: | CHARLENA WHITEHEAD |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/18/2019 |
| Last Updated: | 06/18/2019 |
Provider Practice Location
1312 S 8TH ST
LAS VEGAS
NV
891041638
Practice Location Phone/Fax
| Phone: | 7023850921 |
| Fax: |
Provider Mailing Location
1312 S 8TH ST
LAS VEGAS
NV
891041638
Provider Mailing Phone/Fax
| Phone: | 7023850921 |
| Fax: |