MEDICARE: COMPLETE WELLNESS MEDICAL CENTER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1942978549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE WELLNESS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3838 MAJESTIC DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4437
Country	:	US
Telephone Number	:	602-349-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 MAJESTIC DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4437
Country	:	US
Telephone Number	:	602-349-6043
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFINIE COURSE
Credential	:
Telephone Number	:	602-349-6043

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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Directions to “COMPLETE WELLNESS MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

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