Provider Demographics
NPI:1316650971
Name:NUWELL LIFE
Entity type:Organization
Organization Name:NUWELL LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNC, PHD CAND
Authorized Official - Phone:936-776-8264
Mailing Address - Street 1:280 W LAKE MEAD PKWY # 1099
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7367
Mailing Address - Country:US
Mailing Address - Phone:844-468-9355
Mailing Address - Fax:
Practice Address - Street 1:3388 DALMORE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1722
Practice Address - Country:US
Practice Address - Phone:844-468-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty