Provider Demographics
NPI:1487074860
Name:SMITH, SARA NICOLE
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 BEAVER CREEK CT
Mailing Address - Street 2:#102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1763
Mailing Address - Country:US
Mailing Address - Phone:702-910-0839
Mailing Address - Fax:
Practice Address - Street 1:2716 BEAVER CREEK CT
Practice Address - Street 2:#102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1763
Practice Address - Country:US
Practice Address - Phone:702-910-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner