Provider Demographics
NPI:1255675625
Name:MUCKELROY, RASHONDA D (RASHONDA MUCKELROY)
Entity Type:Individual
Prefix:MISS
First Name:RASHONDA
Middle Name:D
Last Name:MUCKELROY
Suffix:
Gender:F
Credentials:RASHONDA MUCKELROY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 SIMMONS ST
Mailing Address - Street 2:#1-159
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9009
Mailing Address - Country:US
Mailing Address - Phone:702-722-8735
Mailing Address - Fax:
Practice Address - Street 1:5575 SIMMONS ST
Practice Address - Street 2:#1-159
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-9009
Practice Address - Country:US
Practice Address - Phone:702-722-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1703355243171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor