Individual ProviderLilnetra GradyNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address400 Shadow Ln Ste 106, Las Vegas, NV 89106-4355(702) 731-0909(702) 998-2816PECOS EnrollmentBased on the most recent information from CMS, provider Lilnetra Grady is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1619429933Provider TypeIndividualFull NameGrady, LilnetraCredentialNURSE PRACTITIONERGenderFemaleSole ProprietorNoEnumeration Date11/3/2016Last Updated10/9/2019Contact InformationPractice LocationPractice Address400 Shadow Ln Ste 106, Las Vegas, NV 89106-4355Phone(702) 731-0909Fax(702) 826-4767Mailing LocationMailing Address8936 Spanish Ridge Ave Ste 106, Las Vegas, NV 89148-1354Phone(702) 998-2816Fax(702) 998-2991Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense813525NevadaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense209015079IllinoisProvider IdentifiersIDDescriptionIssuerID1619429933DescriptionMedicaidIssuerUnlistedNevada