Provider Demographics
NPI:1225620024
Name:VISORDE, VILMA S (PCA)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:S
Last Name:VISORDE
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KAREN AVE APT 46
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-8867
Mailing Address - Country:US
Mailing Address - Phone:702-613-3398
Mailing Address - Fax:
Practice Address - Street 1:1500 KAREN AVE APT 46
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-8867
Practice Address - Country:US
Practice Address - Phone:702-613-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1704433173OtherDRIVER LICENSE
NV1704433173OtherDL NV