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General NPI Number Information
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NPI Number | 1558147298
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Entity Type | Organization
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Legal Business Name | LAS VEGAS ALLERGY AND WELLNESS LLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 2637 W HORIZON RIDGE PKWY STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-4835
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Country | US
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Telephone | 725-277-0509
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Fax | 855-213-5199
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Provider Business Mailing Address
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Address Line | 2637 W HORIZON RIDGE PKWY STE 110
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City | HENDERSON
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State | NV
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Zip | 89052-4835
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Country | US
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Telephone | 725-277-0509
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Fax | 855-213-5199
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Authorized Official
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Title or Position | CEO
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Name | NOLAN ROGGE
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Credential |
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Telephone | 425-308-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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