Provider Demographics
NPI:1538814850
Name:BOTSWAIN, MAJENTA L
Entity type:Individual
Prefix:
First Name:MAJENTA
Middle Name:L
Last Name:BOTSWAIN
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 1:2620 S MARYLAND PKWY STE 556
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-8300
Mailing Address - Country:US
Mailing Address - Phone:702-337-1133
Mailing Address - Fax:
Practice Address - Street 1:2620 S MARYLAND PKWY STE 556
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-8300
Practice Address - Country:US
Practice Address - Phone:702-337-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider