Provider Demographics
NPI:1194181925
Name:WILMORE, ARIANE
Entity Type:Individual
Prefix:
First Name:ARIANE
Middle Name:
Last Name:WILMORE
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 1:1946 SALVATION ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-7379
Mailing Address - Country:US
Mailing Address - Phone:702-530-7131
Mailing Address - Fax:702-472-8884
Practice Address - Street 1:1946 SALVATION ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-7379
Practice Address - Country:US
Practice Address - Phone:702-530-7131
Practice Address - Fax:702-472-8884
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVNV20161155833172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program