Healthcare Provider Details

I. General information

NPI: 1902779473
Provider Name (Legal Business Name): MRS. RAICHELLE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 S RAINBOW BLVD STE 108
LAS VEGAS NV
89146-6596
US

IV. Provider business mailing address

3311 S RAINBOW BLVD STE 108
LAS VEGAS NV
89146-6596
US

V. Phone/Fax

Practice location:
  • Phone: 855-468-2343
  • Fax:
Mailing address:
  • Phone: 702-703-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number842119
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: