Provider Demographics
NPI:1215324173
Name:AN OASIS WELLNESS
Entity type:Organization
Organization Name:AN OASIS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLWOOD-HORNIACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MMT, LMT,HP
Authorized Official - Phone:702-672-2787
Mailing Address - Street 1:9636 BENDING RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6939
Mailing Address - Country:US
Mailing Address - Phone:702-672-2787
Mailing Address - Fax:702-462-5816
Practice Address - Street 1:9636 BENDING RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6939
Practice Address - Country:US
Practice Address - Phone:702-672-2787
Practice Address - Fax:702-462-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4686251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health