Provider Demographics
NPI:1194473116
Name:LACAYO, LILIANA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:LACAYO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 LAVENDER HILL DR STE 160-154
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2955
Mailing Address - Country:US
Mailing Address - Phone:818-389-5379
Mailing Address - Fax:702-745-0687
Practice Address - Street 1:5270 S FORT APACHE RD STE 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1726
Practice Address - Country:US
Practice Address - Phone:702-776-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV848059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily