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NPI Code Detail

MEDICARE: LISA A DURETTE MD PLLC

MEDICARE: LISA A DURETTE MD PLLC
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
12084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1164873246
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA A DURETTE MD PLLC
Provider Business Mailing Address
First Line : 840 S RANCHO DR STE 4-337
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3837
Country : US
Telephone Number : 702-440-8440
Fax Number : 866-518-0781
Provider Business Practice Location Address
First Line : 526 S TONOPAH DR STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4013
Country : US
Telephone Number : 702-440-8440
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : WANDA WILKINS
Credential :
Telephone Number : 725-246-1483
Provider Enumeration Date : 06/29/2016
Last Update Date : 11/21/2022

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Directions to “LISA A DURETTE MD PLLC ” Practice Location

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