Provider Demographics
NPI:1639634645
Name:STROUGHTER, MARYLENE
Entity Type:Individual
Prefix:
First Name:MARYLENE
Middle Name:
Last Name:STROUGHTER
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 1:2881 S VALLEY VIEW BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0171
Mailing Address - Country:US
Mailing Address - Phone:702-253-1031
Mailing Address - Fax:702-253-9474
Practice Address - Street 1:2881 S VALLEY VIEW BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0171
Practice Address - Country:US
Practice Address - Phone:702-253-1031
Practice Address - Fax:702-253-9474
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant