Provider Demographics
NPI:1851891782
Name:FORD, LIZZIE M
Entity Type:Individual
Prefix:
First Name:LIZZIE
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 S RAINBOW BLVD STE K-441
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2010
Mailing Address - Country:US
Mailing Address - Phone:702-240-3800
Mailing Address - Fax:
Practice Address - Street 1:4012 S RAINBOW BLVD STE K-441
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2010
Practice Address - Country:US
Practice Address - Phone:702-240-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider