Provider Demographics
NPI:1629789342
Name:SIAKI, MARETA I (AA LIBERAL ARTS)
Entity Type:Individual
Prefix:
First Name:MARETA
Middle Name:
Last Name:SIAKI
Suffix:I
Gender:F
Credentials:AA LIBERAL ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 MOUNTAIN VISTA ST APT 226
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4669
Mailing Address - Country:US
Mailing Address - Phone:702-981-8460
Mailing Address - Fax:
Practice Address - Street 1:3850 MOUNTAIN VISTA ST APT 226
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4669
Practice Address - Country:US
Practice Address - Phone:702-981-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00002957927Medicaid