Organization
INTEGRATED MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL CHINENYE GODWIN NP (OWNER)
(323) 347-0008
Entity
Organization
Contact information
Practice address
501 S RANCHO DR STE F38, LAS VEGAS, NV 89106-4834
(323) 347-0008
Mailing address
501 S RANCHO DR STE F38, LAS VEGAS, NV 89106-4834
(323) 347-0008
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/11/2025
Last updated
04/11/2025
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