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General NPI Number Information
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NPI Number | 1063126803
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Entity Type | Individual
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Provider Name | LIEN MATOS LEGRA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 6350 S DURANGODRIVE
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 702-790-8000
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Fax | 702-437-0476
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Provider Business Mailing Address
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Address Line | 4436 EUREKA CIR
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City | LAS VEGAS
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State | NV
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Zip | 89103-3234
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Country | US
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Telephone | 702-205-6964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 836985
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License Number State | NV
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