Healthcare Provider Details

I. General information

NPI: 1477387793
Provider Name (Legal Business Name): WELL NET TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 RADIO CITY ST
LAS VEGAS NV
89135-1114
US

IV. Provider business mailing address

2399 RADIO CITY ST
LAS VEGAS NV
89135-1114
US

V. Phone/Fax

Practice location:
  • Phone: 702-406-1061
  • Fax:
Mailing address:
  • Phone: 702-406-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANE COX
Title or Position: ADMINISTRATOR/ACCESS MANAGER
Credential: WELL NET TELEHEALTH
Phone: 949-664-2796