Organization
RENEWED1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMON DENZEL LESTER FNP-C (OWNER)
(702) 350-1387
Entity
Organization
Contact information
Practice address
401 RYLAND ST STE 200A, RENO, NV 89502-1643
(702) 350-1387
Mailing address
401 RYLAND ST STE 200A, RENO, NV 89502-1643
(702) 350-1387
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194389569
—
NV
Enumeration date
09/07/2024
Last updated
09/07/2024
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