Healthcare Provider Details

I. General information

NPI: 1649189432
Provider Name (Legal Business Name): MEDNOVA HEALTH GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 SAINT ROSE PKWY # 777492
HENDERSON NV
89052-3889
US

IV. Provider business mailing address

3055 SAINT ROSE PKWY # 777492
HENDERSON NV
89052-3889
US

V. Phone/Fax

Practice location:
  • Phone: 725-336-3622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACIE FITZMAURICE
Title or Position: MANAGER
Credential:
Phone: 725-336-3622