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General NPI Number Information
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NPI Number | 1649189432
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Entity Type | Organization
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Legal Business Name | MEDNOVA HEALTH GROUP LTD
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Dates
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Enumeration Date | 09/05/2026
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Last Update Date | 09/05/2026
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Provider Practice Location Address
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Address Line | 3055 SAINT ROSE PKWY # 777492
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City | HENDERSON
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State | NV
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Zip | 89052-3889
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Country | US
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Telephone | 725-336-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 SAINT ROSE PKWY # 777492
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City | HENDERSON
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State | NV
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Zip | 89052-3889
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TRACIE FITZMAURICE
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Credential |
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Telephone | 725-336-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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