Evelina Blodgett
Individual provider Active NPI Counselor · Las Vegas, NV
NPI 1609133263 · NPPES record last updated Apr 19, 2012
Key facts
- NPI
- 1609133263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 00859 (NV)
- Practice address
- 714 E Sahara Ave
Las Vegas, NV 89104-2942 - Phone
- (702) 369-8700
- NPI assigned
- Apr 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00859 | NV | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 00859 | NV | Yes |
Addresses
Primary practice location
714 E Sahara Ave
Las Vegas, NV 89104-2942
Mailing address
447 Leighann Rd
Henderson, NV 89015-6807
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.