Provider Demographics
NPI:1881434223
Name:FAIRCHILD, RHONDA (PRSSS)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:PRSSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 CANOE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5949
Mailing Address - Country:US
Mailing Address - Phone:702-245-1766
Mailing Address - Fax:
Practice Address - Street 1:3441 W SAHARA AVE STE C1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6059
Practice Address - Country:US
Practice Address - Phone:702-445-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-5002175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty