MEDICARE: WAYNNESHA ARTIZE WEDLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11398-C	NV
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1093222697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNNESHA ARTIZE WEDLOW

Provider Business Mailing Address
First Line	:	2300 W SAHARA AVE STE 800
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4397
Country	:	US
Telephone Number	:	702-713-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-713-8207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	03/11/2026

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Directions to “ WAYNNESHA ARTIZE WEDLOW ” Practice Location

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