Provider Demographics
NPI:1750777983
Name:THEWELL
Entity type:Organization
Organization Name:THEWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-282-9355
Mailing Address - Street 1:1485 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5256
Mailing Address - Country:US
Mailing Address - Phone:844-282-9355
Mailing Address - Fax:702-386-0977
Practice Address - Street 1:1485 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5256
Practice Address - Country:US
Practice Address - Phone:844-282-9355
Practice Address - Fax:702-386-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty