Provider Demographics
NPI:1558924134
Name:ESPRECION, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ESPRECION
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:KS
Other - Last Name:ESPRECION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6210 N JONES BLVD UNIT 753611
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-8964
Mailing Address - Country:US
Mailing Address - Phone:702-970-7440
Mailing Address - Fax:
Practice Address - Street 1:3007 EXTRAVAGANT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031
Practice Address - Country:US
Practice Address - Phone:702-970-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver