MEDICARE: MRS. SANDRA NICOLE SCHILLER

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	101YM0800X	Mental Health Counselor		NV

General Provider Information

NPI Number	:	1881026268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA NICOLE SCHILLER

Provider Business Mailing Address
First Line	:	6885 W LONE MOUNTAIN RD
Second Line	:	APT. 358
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5800
Country	:	US
Telephone Number	:	702-785-4837
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 MARTIN LUTHER KING BLVD
Second Line	:	SUITE 100
City	:	N. LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-802-5757
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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