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General NPI Number Information
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NPI Number | 1194306274
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Entity Type | Organization
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Legal Business Name | RESTORED MIND PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 500 N RAINBOW BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89107-1061
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Country | US
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Telephone | 702-508-6608
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Fax | 702-508-6643
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Provider Business Mailing Address
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Address Line | 500 N RAINBOW BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89107-1061
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Country | US
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Telephone | 702-508-6608
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Fax | 702-508-6643
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | UGOEZI BRIDGET AGU
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Credential | DNP
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Telephone | 702-964-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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