NPIMap

Organization Active NPI

Mediwell Pro Advance Care LLC

  • Psychiatry Physician
  • Henderson, NV
National Provider Identifier
1184336133
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MEDIWELL PRO ADVANCE CARE LLC
Practice address
2161 Eaglecloud Dr
Henderson, NV 89074-1597
Phone
(702) 619-8730
NPI assigned
Dec 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yaneisy RaveloNPI 1720529704
Title
Manager
Phone
(702) 619-8730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2161 Eaglecloud Dr
Henderson, NV 89074-1597

Mailing address

2161 Eaglecloud Dr
Henderson, NV 89074-1597
Phone (702) 619-8730

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1184336133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2161 EAGLECLOUD DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741597",
            "telephone_number": "702-619-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2161 EAGLECLOUD DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741597",
            "telephone_number": "702-619-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIWELL PRO ADVANCE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "RAVELO",
        "authorized_official_first_name": "YANEISY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-619-8730"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.