Healthcare Provider Details

I. General information

NPI: 1124739735
Provider Name (Legal Business Name): MILTON DY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 DESERT CLOVER CT
LAS VEGAS NV
89129-5745
US

IV. Provider business mailing address

7001 DESERT CLOVER CT
LAS VEGAS NV
89129-5745
US

V. Phone/Fax

Practice location:
  • Phone: 408-677-9528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN91768
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number332386
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number886175
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: