Provider Demographics
NPI:1164599478
Name:SIERRA NEUROLOGY LLP
Entity Type:Organization
Organization Name:SIERRA NEUROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRACLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGSUWANA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-883-4411
Mailing Address - Street 1:896 W NYE LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1544
Mailing Address - Country:US
Mailing Address - Phone:775-883-4411
Mailing Address - Fax:775-883-1701
Practice Address - Street 1:896 W NYE LN
Practice Address - Street 2:SUITE 203
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1544
Practice Address - Country:US
Practice Address - Phone:775-883-4411
Practice Address - Fax:775-883-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1253261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46413Medicare UPIN