MEDICARE: PROGRESSIVE WELLNESS & AESTHETICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1255268132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE WELLNESS & AESTHETICS, LLC

Provider Business Mailing Address
First Line	:	4275 BURNHAM AVE STE 325A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 325A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8212
Country	:	US
Telephone Number	:	702-703-6763
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER ELLIS
Credential	:	FNP-C
Telephone Number	:	702-703-6763

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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