MEDICARE: MRS. BEVERLY ANN HILLBRADSHAW MS., LADC

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	251S00000X	Community/Behavioral Health Agency	826-L	NV

General Provider Information

NPI Number	:	1881979219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY ANN HILLBRADSHAW MS., LADC

Provider Business Mailing Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-522-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-522-9962
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	01/24/2013

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