Provider Demographics
NPI:1437441227
Name:LIDE, J'REE J'NEL
Entity Type:Individual
Prefix:MS
First Name:J'REE
Middle Name:J'NEL
Last Name:LIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:J'REE
Other - Middle Name:J'NEL
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2760 LAKE SAHARA DR
Mailing Address - Street 2:#108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3438
Mailing Address - Country:US
Mailing Address - Phone:702-222-0792
Mailing Address - Fax:
Practice Address - Street 1:2760 LAKE SAHARA DR
Practice Address - Street 2:#108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3438
Practice Address - Country:US
Practice Address - Phone:702-222-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator