Provider Demographics
NPI:1336494400
Name:DUPREE, TASHAE (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:TASHAE
Middle Name:
Last Name:DUPREE
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ORR AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030
Mailing Address - Country:US
Mailing Address - Phone:702-688-2079
Mailing Address - Fax:702-658-8702
Practice Address - Street 1:609 ORR AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5688
Practice Address - Country:US
Practice Address - Phone:702-688-2079
Practice Address - Fax:702-658-8702
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7368HIC-0376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator