Provider Demographics
NPI:1831472950
Name:NAZAIRE, GLENDA ROVERO
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:ROVERO
Last Name:NAZAIRE
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 1:830 N SLOAN LN APT 201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2789
Mailing Address - Country:US
Mailing Address - Phone:702-332-9387
Mailing Address - Fax:
Practice Address - Street 1:830 N SLOAN LN APT 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2789
Practice Address - Country:US
Practice Address - Phone:702-332-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner