Provider Demographics
NPI:1376002717
Name:JOHNSON, ALAYAH SHANECE
Entity Type:Individual
Prefix:
First Name:ALAYAH
Middle Name:SHANECE
Last Name:JOHNSON
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 1:3655 E SAHARA AVE APT NO
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4953
Mailing Address - Country:US
Mailing Address - Phone:702-241-3853
Mailing Address - Fax:
Practice Address - Street 1:4850 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3705
Practice Address - Country:US
Practice Address - Phone:702-871-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2104925457OtherNEVADA
2104925457OtherNEVADA