Provider Demographics
NPI:1497417539
Name:SABU, SIBIMOL (NP)
Entity Type:Individual
Prefix:
First Name:SIBIMOL
Middle Name:
Last Name:SABU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S BRUCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1778
Mailing Address - Country:US
Mailing Address - Phone:702-732-2438
Mailing Address - Fax:702-737-5043
Practice Address - Street 1:2545 S BRUCE ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1778
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-737-5043
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV845360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner