Healthcare Provider Details

I. General information

NPI: 1225851967
Provider Name (Legal Business Name): PRINCE WESLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 S EASTERN AVE STE 150
HENDERSON NV
89052-5576
US

IV. Provider business mailing address

11500 S EASTERN AVE STE 150
HENDERSON NV
89052-5576
US

V. Phone/Fax

Practice location:
  • Phone: 702-751-5055
  • Fax: 702-552-7138
Mailing address:
  • Phone: 702-751-5055
  • Fax: 702-552-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: