# IDENTITY HORMONES NV LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780441998
- **Authorized official:** AMANDA WILKINSON (BUSINESS OPERATIONS DIRECTOR)
- **Authorized official phone:** (602) 796-2559

## Contact information

- **Practice address:** 1701 N GREEN VALLEY PKWY STE F, HENDERSON, NV 89074-5885
- **Practice address phone:** (702) 661-3438
- **Mailing address:** 1701 N GREEN VALLEY PKWY STE F, HENDERSON, NV 89074-5885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/04/2024
- **Last updated:** 02/19/2025