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General NPI Number Information
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NPI Number | 1750777983
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Entity Type | Organization
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Legal Business Name | THEWELL
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 1485 E FLAMINGO RD
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City | LAS VEGAS
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State | NV
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Zip | 89119-5256
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Country | US
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Telephone | 844-282-9355
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Fax | 702-386-0977
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Provider Business Mailing Address
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Address Line | 1485 E FLAMINGO RD
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City | LAS VEGAS
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State | NV
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Zip | 89119-5256
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Country | US
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Telephone | 844-282-9355
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Fax | 702-386-0977
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Authorized Official
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Title or Position | MSO
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Name | DANIEL GATH
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Credential |
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Telephone | 844-282-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN001599
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License Number State | NV
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