Healthcare Provider Details

I. General information

NPI: 1710945092
Provider Name (Legal Business Name): HENDERSON OB/GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E LAKE MEAD PKWY STE 307 SUITE 307
HENDERSON NV
89015-6444
US

IV. Provider business mailing address

PO BOX 530124
HENDERSON NV
89053-0124
US

V. Phone/Fax

Practice location:
  • Phone: 702-568-6108
  • Fax: 702-568-8603
Mailing address:
  • Phone: 702-568-6108
  • Fax: 702-568-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ORLANDIS L. WELLS
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 702-568-6108