MEDICARE: SANDRA NAIL HOLLOWAY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1639685373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA NAIL HOLLOWAY

Provider Business Mailing Address
First Line	:	355 COMMON CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-6143
Country	:	US
Telephone Number	:	702-272-5855
Fax Number	:	702-749-6334

Provider Business Practice Location Address
First Line	:	355 COMMON CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-6143
Country	:	US
Telephone Number	:	702-272-5855
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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Directions to “ SANDRA NAIL HOLLOWAY ” Practice Location

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