Healthcare Provider Details

I. General information

NPI: 1538653589
Provider Name (Legal Business Name): SARAH MANGAYAO NAZERIMONFARED APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89012-3516
US

IV. Provider business mailing address

3459 SAINT ROSE PKWY # 120-481
HENDERSON NV
89052-4601
US

V. Phone/Fax

Practice location:
  • Phone: 702-781-4800
  • Fax: 702-664-6755
Mailing address:
  • Phone: 702-781-4800
  • Fax: 702-664-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002933
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN002933
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN002933
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: