Provider Demographics
NPI:1770856304
Name:WEBB, SUE ANN
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:WEBB
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 1:1327 H ST
Mailing Address - Street 2:APT 427
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2976
Mailing Address - Country:US
Mailing Address - Phone:870-415-2604
Mailing Address - Fax:
Practice Address - Street 1:1327 H ST
Practice Address - Street 2:APT 427
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2976
Practice Address - Country:US
Practice Address - Phone:870-415-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4100739763225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner