Organization
NU WAVE ESWT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY BALLOW (CREDENTIALING SPECIALIST)
(702) 202-3431
Entity
Organization
Contact information
Practice address
4510 WEST DIABLO AVE, SUITE A110, LAS VEGAS, NV 89118
(702) 948-0604
Mailing address
7365 PRAIRIE FALCON RD, SUITE 140, LAS VEGAS, NV 89128-2263
(702) 202-3431
(702) 202-3455
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
02/06/2009
Last updated
02/06/2009
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