Provider Demographics
NPI:1821961277
Name:LONG LIVE WELLNESS
Entity type:Organization
Organization Name:LONG LIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAMENCO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:702-683-6337
Mailing Address - Street 1:908 ABILENE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9545
Mailing Address - Country:US
Mailing Address - Phone:702-683-6337
Mailing Address - Fax:702-901-8096
Practice Address - Street 1:908 ABILENE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9545
Practice Address - Country:US
Practice Address - Phone:702-683-6337
Practice Address - Fax:702-901-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty