Provider Demographics
NPI:1164250833
Name:SMALLS-LUDOVICO, CIANA JADE (LPN)
Entity type:Individual
Prefix:
First Name:CIANA
Middle Name:JADE
Last Name:SMALLS-LUDOVICO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CIANA
Other - Middle Name:JADE
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:8980 OCEANSIDE SLOPES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-7525
Mailing Address - Country:US
Mailing Address - Phone:702-713-4256
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3514
Practice Address - Country:US
Practice Address - Phone:702-982-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse