Provider Demographics
NPI:1558147298
Name:LAS VEGAS ALLERGY AND WELLNESS LLC
Entity Type:Organization
Organization Name:LAS VEGAS ALLERGY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-308-0119
Mailing Address - Street 1:2637 W HORIZON RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4835
Mailing Address - Country:US
Mailing Address - Phone:725-277-0509
Mailing Address - Fax:855-213-5199
Practice Address - Street 1:2637 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4835
Practice Address - Country:US
Practice Address - Phone:725-277-0509
Practice Address - Fax:855-213-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2024-01-08
Deactivation Date:2023-12-23
Deactivation Code:
Reactivation Date:2024-01-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty