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General NPI Number Information
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NPI Number | 1568148856
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Entity Type | Organization
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Legal Business Name | MAAT WELLNESS CENTEER
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 4324 S EASTERN AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89119-6064
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Country | US
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Telephone | 702-743-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 4324 S EASTERN AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89119-6064
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Country | US
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Telephone | 702-743-7314
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIE J BORRES
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Credential | AGACNP-BC
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Telephone | 702-409-9873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care 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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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