Provider Demographics
NPI:1588288617
Name:SIERRA WELLNESS LLC
Entity type:Organization
Organization Name:SIERRA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:513-545-4745
Mailing Address - Street 1:1694 WICKLOW WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6048
Mailing Address - Country:US
Mailing Address - Phone:513-545-4745
Mailing Address - Fax:
Practice Address - Street 1:1694 WICKLOW WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6048
Practice Address - Country:US
Practice Address - Phone:702-446-0399
Practice Address - Fax:725-251-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty