Provider Demographics
NPI:1609666130
Name:DOVE, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:DOVE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W TROPICANA AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4637
Mailing Address - Country:US
Mailing Address - Phone:702-524-1177
Mailing Address - Fax:
Practice Address - Street 1:6255 W TROPICANA AVE APT 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4637
Practice Address - Country:US
Practice Address - Phone:702-524-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant