Healthcare Provider Details

I. General information

NPI: 1548885866
Provider Name (Legal Business Name): SANDRA MARIE HILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 S JONES BLVD
LAS VEGAS NV
89118-3302
US

IV. Provider business mailing address

3550 W CHEYENNE AVE STE 130
NORTH LAS VEGAS NV
89032-8252
US

V. Phone/Fax

Practice location:
  • Phone: 702-659-9090
  • Fax: 702-331-5219
Mailing address:
  • Phone: 702-331-1917
  • Fax: 702-331-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number828322
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number828322
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number828322
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: