Provider Demographics
NPI:1215635305
Name:LIGHTNING VIP PLLC
Entity type:Organization
Organization Name:LIGHTNING VIP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTNING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:260-580-3212
Mailing Address - Street 1:2900 N GREEN VALLEY PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0408
Mailing Address - Country:US
Mailing Address - Phone:725-243-1058
Mailing Address - Fax:702-718-6905
Practice Address - Street 1:2900 N GREEN VALLEY PKWY STE 114
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0408
Practice Address - Country:US
Practice Address - Phone:725-243-1058
Practice Address - Fax:702-718-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty