MEDICARE: LISA MARIE BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	CHW1-6450	NV

General Provider Information

NPI Number	:	1336084979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE BUTLER

Provider Business Mailing Address
First Line	:	2125 N LAS VEGAS BLVD APT 1076
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 NORTH MARTIN LUTHER KING BLVD
Second Line	:	#214
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-747-1222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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