Provider Demographics
NPI:1780321125
Name:BOTEN, LETICIA VANESSA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:VANESSA
Last Name:BOTEN
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 1:904 W 7TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2737
Mailing Address - Country:US
Mailing Address - Phone:775-685-3301
Mailing Address - Fax:775-384-3705
Practice Address - Street 1:904 W 7TH ST STE 305
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2737
Practice Address - Country:US
Practice Address - Phone:775-685-3301
Practice Address - Fax:775-384-3705
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVR155255A374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty