Provider Demographics
NPI:1356842371
Name:BEAR, CHARLA D
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:D
Last Name:BEAR
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 1:1600 E DESERT INN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2505
Mailing Address - Country:US
Mailing Address - Phone:702-795-4357
Mailing Address - Fax:702-740-4357
Practice Address - Street 1:1600 E DESERT INN RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2505
Practice Address - Country:US
Practice Address - Phone:702-795-4357
Practice Address - Fax:702-740-4357
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant