Healthcare Provider Details

I. General information

NPI: 1295190304
Provider Name (Legal Business Name): SARA DOUGLAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MEDICAL CENTER DR STE 203
DAYTON NV
89403-7459
US

IV. Provider business mailing address

PO BOX 2168
CARSON CITY NV
89702-2168
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7630
  • Fax:
Mailing address:
  • Phone: 775-445-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002052
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225858
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: