Provider Demographics
NPI:1508525080
Name:STROTHMAN, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:STROTHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S RAINBOW BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0895
Mailing Address - Country:US
Mailing Address - Phone:970-261-5789
Mailing Address - Fax:
Practice Address - Street 1:1555 E FLAMINGO RD STE 117
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5259
Practice Address - Country:US
Practice Address - Phone:970-261-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant