Provider Demographics
NPI:1639433717
Name:TURNER, ALFORTRA DIANE
Entity Type:Individual
Prefix:
First Name:ALFORTRA
Middle Name:DIANE
Last Name:TURNER
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 1:1237 W ALEXANDER RD APT 150
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9090
Mailing Address - Country:US
Mailing Address - Phone:702-806-3735
Mailing Address - Fax:
Practice Address - Street 1:1237 W ALEXANDER RD APT 150
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9090
Practice Address - Country:US
Practice Address - Phone:702-806-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner