Provider Demographics
NPI:1255945580
Name:SMYLIE, MALIA (APRN, CNM)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:SMYLIE
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 GARDEN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 78
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1910
Practice Address - Country:US
Practice Address - Phone:702-269-6018
Practice Address - Fax:702-269-6081
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832625367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife