Healthcare Provider Details

I. General information

NPI: 1255268132
Provider Name (Legal Business Name): PROGRESSIVE WELLNESS & AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 BURNHAM AVE STE 325A
LAS VEGAS NV
89119-8212
US

IV. Provider business mailing address

4275 BURNHAM AVE STE 325A
LAS VEGAS NV
89119-8212
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-6763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ELLIS
Title or Position: OWNER
Credential: FNP-C
Phone: 702-703-6763