Healthcare Provider Details

I. General information

NPI: 1316650971
Provider Name (Legal Business Name): NUWELL LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3388 DALMORE ST
HENDERSON NV
89044-1722
US

IV. Provider business mailing address

280 W LAKE MEAD PKWY # 1099
HENDERSON NV
89015-7367
US

V. Phone/Fax

Practice location:
  • Phone: 844-468-9355
  • Fax:
Mailing address:
  • Phone: 844-468-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: TRACI MEADOWS
Title or Position: OWNER
Credential: MS, CNC, PHD CAND.
Phone: 936-776-8264