MEDICARE: LILLIAN SHANNON GOINS

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	374U00000X	Home Health Aide	E7994222020-5	NV

General Provider Information

NPI Number	:	1538745831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN SHANNON GOINS

Provider Business Mailing Address
First Line	:	3167 LA MANCHA WAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-3654
Country	:	US
Telephone Number	:	702-286-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 N VALADEZ ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5247
Country	:	US
Telephone Number	:	702-286-2987
Fax Number	:

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

Provider Enumeration Date	:	03/18/2021
Last Update Date	:	03/18/2021

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