Provider Demographics
NPI:1902360373
Name:FAUCETT, DEANNA CAMILLE
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:CAMILLE
Last Name:FAUCETT
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 1:6816 WHITE SANDS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5334
Mailing Address - Country:US
Mailing Address - Phone:702-238-3037
Mailing Address - Fax:702-363-6756
Practice Address - Street 1:6816 WHITE SANDS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5334
Practice Address - Country:US
Practice Address - Phone:702-238-3037
Practice Address - Fax:702-363-6756
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20191058990251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management