Provider Demographics
NPI:1942999255
Name:DIVINE HEALTHCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:DIVINE HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMWANGHE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:470-233-3464
Mailing Address - Street 1:10739 BERNINI DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4259
Mailing Address - Country:US
Mailing Address - Phone:470-233-3464
Mailing Address - Fax:
Practice Address - Street 1:10739 BERNINI DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4259
Practice Address - Country:US
Practice Address - Phone:470-233-3464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty