Provider Demographics
NPI:1750178554
Name:HARGRAVE-MARTIN, LISA LEE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:HARGRAVE-MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 S EASTERN AVE STE 2014660S
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6137
Mailing Address - Country:US
Mailing Address - Phone:702-970-0574
Mailing Address - Fax:
Practice Address - Street 1:4660 S EASTERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6139
Practice Address - Country:US
Practice Address - Phone:702-462-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker