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General NPI Number Information
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NPI Number | 1255020889
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Entity Type | Organization
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Legal Business Name | MINDSHIFT NUTRITION & WELLNESS, LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 7251 W LAKE MEAD BLVD STE 300
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City | LAS VEGAS
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State | NV
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Zip | 89128-8380
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Country | US
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Telephone | 725-301-0959
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Fax | 702-941-9075
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Provider Business Mailing Address
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Address Line | 3211 STRATFORD HALL CT
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City | LAS VEGAS
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State | NV
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Zip | 89135-2140
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Country | US
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Telephone | 702-817-0385
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Fax |
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Authorized Official
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Title or Position | DIETITIAN AND OWNER
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Name | JENNIFER DAWN MILLER
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Credential |
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Telephone | 725-301-0959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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