Provider Demographics
NPI:1679363295
Name:MARTIN, LILY (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 GRAN VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4825
Mailing Address - Country:US
Mailing Address - Phone:725-272-0851
Mailing Address - Fax:
Practice Address - Street 1:1387 GRAN VISTA AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4825
Practice Address - Country:US
Practice Address - Phone:725-272-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI66657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily