Healthcare Provider Details

I. General information

NPI: 1063287308
Provider Name (Legal Business Name): NULIFE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S EASTERN AVE STE 4E
LAS VEGAS NV
89119-3101
US

IV. Provider business mailing address

6000 S EASTERN AVE STE 4E
LAS VEGAS NV
89119-3101
US

V. Phone/Fax

Practice location:
  • Phone: 702-840-5343
  • Fax:
Mailing address:
  • Phone: 702-840-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PIERCE
Title or Position: AGENT
Credential:
Phone: 702-840-5343