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General NPI Number Information
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NPI Number | 1679363295
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Entity Type | Individual
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Provider Name | LILY MARTIN MSN, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1387 GRAN VISTA AVE
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City | HENDERSON
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State | NV
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Zip | 89012-4825
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Country | US
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Telephone | 725-272-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 1387 GRAN VISTA AVE
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City | HENDERSON
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State | NV
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Zip | 89012-4825
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Country | US
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Telephone | 725-272-0851
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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 | 66657
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License Number State | HI
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