Provider Demographics
NPI:1770163214
Name:IN GOOD HEALTH PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IN GOOD HEALTH PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-522-6108
Mailing Address - Street 1:5920 S RAINBOW BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4209
Mailing Address - Country:US
Mailing Address - Phone:702-522-6108
Mailing Address - Fax:702-989-4805
Practice Address - Street 1:5495 S RAINBOW BLVD STE 202B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1873
Practice Address - Country:US
Practice Address - Phone:702-522-6108
Practice Address - Fax:702-989-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty