Lisa Elaine Agnew
Individual provider Active NPI Specialist · Las Vegas, NV
NPI 1780873802 · NPPES record last updated Jun 9, 2011
Key facts
- NPI
- 1780873802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- NVMT.0766 (NV)
- Practice address
- 1049 S Rainbow Blvd
Las Vegas, NV 89145-6232 - Phone
- (702) 274-0054
- NPI assigned
- Oct 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NVMT.0766 | NV | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NVMT.0766 | NV | Yes |
Addresses
Primary practice location
1049 S Rainbow Blvd
Las Vegas, NV 89145-6232
Mailing address
PO Box 28254
Las Vegas, NV 89126-2254
Phone (702) 274-0054
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.