Provider Demographics
NPI:1285909648
Name:CHILDRESS, CLAUDIA LYNNE (BSHS)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:LYNNE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 ONA MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4867
Mailing Address - Country:US
Mailing Address - Phone:702-490-7211
Mailing Address - Fax:
Practice Address - Street 1:1946 ONA MARIE AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4867
Practice Address - Country:US
Practice Address - Phone:702-490-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNONE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker