MEDICARE: MALAY HIM FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	854417	NV
2	363LF0000X	Family Nurse Practitioner	209013736	IL

General Provider Information

NPI Number	:	1538520655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAY HIM FNP

Provider Business Mailing Address
First Line	:	3290 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0738
Country	:	US
Telephone Number	:	702-254-3084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3290 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0738
Country	:	US
Telephone Number	:	702-254-3084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	04/13/2026

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