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General NPI Number Information
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NPI Number | 1124949664
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Entity Type | Organization
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Legal Business Name | RAVEN HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 2270 COMMERCIAL DR UNIT 2
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City | PAHRUMP
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State | NV
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Zip | 89048-4704
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Country | US
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Telephone | 725-253-5127
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 PARK DR
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City | FAIRBANKS
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State | AK
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Zip | 99709-4714
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Country | US
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Telephone | 907-388-6308
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGEL AMBROSE
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Credential |
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Telephone | 907-388-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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