MEDICARE: MANIFEST HEALTH LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1417631706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANIFEST HEALTH LLC

Provider Business Mailing Address
First Line	:	9033 BLACK ELK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1122
Country	:	US
Telephone Number	:	702-203-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 S VALLEY VIEW BLVD STE 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0170
Country	:	US
Telephone Number	:	702-203-7996
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA SUE GUERRA
Credential	:	APRN
Telephone Number	:	702-203-7996

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “MANIFEST HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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