Provider Demographics
NPI:1255020889
Name:MINDSHIFT NUTRITION & WELLNESS, LLC
Entity type:Organization
Organization Name:MINDSHIFT NUTRITION & WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-301-0959
Mailing Address - Street 1:3211 STRATFORD HALL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2140
Mailing Address - Country:US
Mailing Address - Phone:702-817-0385
Mailing Address - Fax:
Practice Address - Street 1:7251 W LAKE MEAD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8380
Practice Address - Country:US
Practice Address - Phone:725-301-0959
Practice Address - Fax:702-941-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty