Healthcare Provider Details

I. General information

NPI: 1780955187
Provider Name (Legal Business Name): LAURA MARIE MILLSAP P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AND A ST
HAWTHORNE NV
89415-1510
US

IV. Provider business mailing address

PO BOX 1510 1ST AND A ST
HAWTHORNE NV
89415-1510
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-2461
  • Fax: 775-945-2359
Mailing address:
  • Phone: 775-945-2461
  • Fax: 775-945-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1322
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: