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NPI Code Detail

MEDICARE: VITALITY MEDICAL AND WELLNESS CENTER

MEDICARE: VITALITY MEDICAL AND WELLNESS CENTER
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
1363LF0000XFamily Nurse PractitionerRN37436NV

General Provider Information

NPI Number : 1629486113
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALITY MEDICAL AND WELLNESS CENTER
Provider Business Mailing Address
First Line : 5765 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-5625
Country : US
Telephone Number : 702-731-1200
Fax Number : 702-736-6302
Provider Business Practice Location Address
First Line : 5765 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-5625
Country : US
Telephone Number : 702-731-1200
Fax Number : 702-736-6302
Authorized Official
Title or Position : PROVIDER/OWNER
Name : CRISTY M THOMAS
Credential : DNP
Telephone Number : 702-731-1200
Provider Enumeration Date : 07/28/2014
Last Update Date : 06/22/2022

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Directions to “VITALITY MEDICAL AND WELLNESS CENTER ” Practice Location

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