=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477423903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLEE HEALTH MEDICAL INSTITUTE NEVADA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 S. SAHARA AVE SUITE B5
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-491-8123
-----------------------------------------------------
Fax | 310-491-8123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 S NEVADA HIGHWAY 160 STE 104
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-491-8123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LARRY NWAFOR SR.
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 310-491-8123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------