Provider Demographics
NPI:1568527323
Name:JACKLIN, SADONA HELEN (APRN)
Entity Type:Individual
Prefix:
First Name:SADONA
Middle Name:HELEN
Last Name:JACKLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SADONA
Other - Middle Name:HELEN
Other - Last Name:MEUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:9120 W POST RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2427
Practice Address - Country:US
Practice Address - Phone:702-870-2229
Practice Address - Fax:702-870-0515
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000744363L00000X
NV21286363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568527323Medicaid