Provider Demographics
NPI:1033986070
Name:LEGACY, ISIS
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:LEGACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 LORILYN AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6385
Mailing Address - Country:US
Mailing Address - Phone:702-902-6442
Mailing Address - Fax:
Practice Address - Street 1:4423 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3703
Practice Address - Country:US
Practice Address - Phone:702-458-1137
Practice Address - Fax:702-458-1423
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845934376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide