Provider Demographics
NPI:1861851222
Name:COMPLETE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:COMPLETE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-600-9037
Mailing Address - Street 1:2920 N GREEN VALLEY PKWY
Mailing Address - Street 2:BUILDING 2, STE 215
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0406
Mailing Address - Country:US
Mailing Address - Phone:702-750-0002
Mailing Address - Fax:888-534-3176
Practice Address - Street 1:2920 N GREEN VALLEY PKWY
Practice Address - Street 2:BUILDING 2, STE 215
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0406
Practice Address - Country:US
Practice Address - Phone:702-750-0002
Practice Address - Fax:888-534-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN00437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty