MEDICARE: SANDRA MARIE HILL APN

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	163WG0000X	General Practice Registered Nurse	828322	NV
2	207Q00000X	Family Medicine Physician	828322	NV
3	363L00000X	Nurse Practitioner	828322	NV

General Provider Information

NPI Number	:	1548885866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARIE HILL APN

Provider Business Mailing Address
First Line	:	3550 W CHEYENNE AVE STE 130
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8252
Country	:	US
Telephone Number	:	702-331-1917
Fax Number	:	702-331-5219

Provider Business Practice Location Address
First Line	:	6330 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3302
Country	:	US
Telephone Number	:	702-659-9090
Fax Number	:	702-331-5219

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	10/16/2020

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