Provider Demographics
NPI:1346225976
Name:HAWORTH, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2482 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2728
Mailing Address - Country:US
Mailing Address - Phone:702-719-6003
Mailing Address - Fax:702-719-6007
Practice Address - Street 1:2482 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2728
Practice Address - Country:US
Practice Address - Phone:702-719-6003
Practice Address - Fax:702-719-6007
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
V107404Medicare PIN