MEDICARE: SAHARA FAMILY PRACTICE, PLLC

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	363L00000X	Nurse Practitioner	APN000709	NV

General Provider Information

NPI Number	:	1689986085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHARA FAMILY PRACTICE, PLLC

Provider Business Mailing Address
First Line	:	2310 PASEO DEL PRADO STE A201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4330
Country	:	US
Telephone Number	:	702-368-5656
Fax Number	:	702-368-5654

Provider Business Practice Location Address
First Line	:	2310 PASEO DEL PRADO STE A201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4330
Country	:	US
Telephone Number	:	702-368-5656
Fax Number	:	702-368-5654

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. SALLY K MILLER
Credential	:	APRN
Telephone Number	:	702-368-5656

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/17/2010

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