Provider Demographics
NPI:1184495616
Name:SLAY, EUN SOOK (LPN)
Entity type:Individual
Prefix:
First Name:EUN
Middle Name:SOOK
Last Name:SLAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 CASCADE CLIFFS CT # 287W
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7216
Mailing Address - Country:US
Mailing Address - Phone:310-292-0004
Mailing Address - Fax:
Practice Address - Street 1:3930 HOWARD HUGHES PKWY # 287W
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0943
Practice Address - Country:US
Practice Address - Phone:702-560-2192
Practice Address - Fax:866-241-4406
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862856164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse