Healthcare Provider Details

I. General information

NPI: 1811223704
Provider Name (Legal Business Name): WELLNESS HORIZONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 FLORA DR
SPRING CREEK NV
89815-5126
US

IV. Provider business mailing address

PO BOX 16
ELKO NV
89803-0016
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-9355
  • Fax:
Mailing address:
  • Phone: 775-777-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberRN52119
License Number StateNV

VIII. Authorized Official

Name: MS. JAN LIENKE BOYER
Title or Position: MANAGING MEMBER
Credential: RN, MS
Phone: 775-738-9464