Provider Demographics
NPI:1801859772
Name:MILLER, LISA R (MD FAAP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10001 S EASTERN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3908
Mailing Address - Country:US
Mailing Address - Phone:702-566-2400
Mailing Address - Fax:702-433-2477
Practice Address - Street 1:10001 S EASTERN AVE STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3908
Practice Address - Country:US
Practice Address - Phone:702-566-2400
Practice Address - Fax:702-433-2477
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9898208000000X, 2080A0000X
NVNV9898207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016782Medicaid
NV35062Medicare PIN
G89184Medicare UPIN