Healthcare Provider Details

I. General information

NPI: 1679363295
Provider Name (Legal Business Name): LILY MARTIN MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 S JONES BLVD
LAS VEGAS NV
89146-1284
US

IV. Provider business mailing address

1294 S JONES BLVD
LAS VEGAS NV
89146-1284
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-1887
  • Fax: 702-877-4536
Mailing address:
  • Phone: 702-877-1887
  • Fax: 702-877-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66657
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: