Provider Demographics
NPI:1013429554
Name:CLANCY, BRIANNA RAY
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RAY
Last Name:CLANCY
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 1:5400 RAMA CIR
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7826
Mailing Address - Country:US
Mailing Address - Phone:775-636-2658
Mailing Address - Fax:
Practice Address - Street 1:5400 RAMA CIR
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-7826
Practice Address - Country:US
Practice Address - Phone:775-636-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV102340124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid