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General NPI Number Information
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NPI Number | 1932909595
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Entity Type | Organization
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Legal Business Name | ELEVATED LV MEDICAL GROUPS INC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 2915 W CHARLESTON BLVD STE 180
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City | LAS VEGAS
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State | NV
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Zip | 89102-1903
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Country | US
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Telephone | 725-259-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 5958 PIRATES DELIGHT AVE
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City | LAS VEGAS
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State | NV
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Zip | 89139-6972
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Country | US
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Telephone | 725-259-5787
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | PEACHES DUON
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Credential | NP
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Telephone | 725-259-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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