Healthcare Provider Details

I. General information

NPI: 1154726735
Provider Name (Legal Business Name): WRM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2014
Last Update Date: 10/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8826 S EASTERN AVE STE 111
LAS VEGAS NV
89123-4826
US

IV. Provider business mailing address

8826 S EASTERN AVE STE 111
LAS VEGAS NV
89123-4826
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-5080
  • Fax: 702-297-6586
Mailing address:
  • Phone: 702-478-5080
  • Fax: 702-297-6586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2001283320
License Number StateNV

VIII. Authorized Official

Name: SHERRY LOUISE HOPKINS
Title or Position: PRESIDENT
Credential: CPM
Phone: 702-478-5080