Provider Demographics
NPI:1912769688
Name:PRYOR, STANISHA DIANE
Entity Type:Individual
Prefix:
First Name:STANISHA
Middle Name:DIANE
Last Name:PRYOR
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 1:6330 WHISPERING CREEK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5720
Mailing Address - Country:US
Mailing Address - Phone:702-268-9991
Mailing Address - Fax:
Practice Address - Street 1:6330 WHISPERING CREEK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5720
Practice Address - Country:US
Practice Address - Phone:702-268-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0028374J00000X
NVCHW1-5646172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374J00000XNursing Service Related ProvidersDoula