Provider Demographics
NPI:1518416585
Name:IRELAND, PARIS
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:IRELAND
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 1:3415 W CRAIG RD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5110
Mailing Address - Country:US
Mailing Address - Phone:702-636-8598
Mailing Address - Fax:
Practice Address - Street 1:3415 W CRAIG RD
Practice Address - Street 2:SUITE #209
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5110
Practice Address - Country:US
Practice Address - Phone:702-636-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT 7944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist