Lisa Elaine Agnew
Specialist in Las Vegas, NV. Individual provider (NPI-1).
NPI number1780873802
StatusActive
Last updated in NPPESJun 9, 2011
Details
- NPI
- 1780873802
- Entity type
- Individual (NPI-1)
- Name
- Lisa Elaine Agnew
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 15, 2007
- Last updated
- Jun 9, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | NVMT.0766 | NV | Yes |
Practice location
1049 S Rainbow BlvdLas Vegas, NV 89145-6232
Phone 702-274-0054
Mailing address
Po Box 28254Las Vegas, NV 89126-2254
Phone 702-274-0054
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