Provider Demographics
NPI:1205398500
Name:VENTURA, MICHAELLE D'JENANE
Entity Type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:D'JENANE
Last Name:VENTURA
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 1:3879 MONTHILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6231
Mailing Address - Country:US
Mailing Address - Phone:702-816-9773
Mailing Address - Fax:
Practice Address - Street 1:3879 MONTHILL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6231
Practice Address - Country:US
Practice Address - Phone:702-816-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care