Provider Demographics
NPI:1174294896
Name:FOX, BRITTIN NICOLE
Entity Type:Individual
Prefix:
First Name:BRITTIN
Middle Name:NICOLE
Last Name:FOX
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 1:98 E LAKE MEAD PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6443
Mailing Address - Country:US
Mailing Address - Phone:702-433-3038
Mailing Address - Fax:
Practice Address - Street 1:98 E LAKE MEAD PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6443
Practice Address - Country:US
Practice Address - Phone:702-433-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner