Doctor Name: | AMANDA NICOLE LILLY |
NPI Number: | 1003290206 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | NP17720 |
Business Practice Address: | 600 W 3rd St Mansfield, OH - 449062633 |
Business Phone Number: | 4195226191 |
Business Fax Number: | 4195256723 |
Mailing Address: | 600 W 3rd St, MANSFIELD |
State: | OH |
Postal Code: | 449062633 |
Phone Number: | 4195226191 |
Fax Number: | 4195256723 |
NPI Enumeration Date: | 07/17/2015 |
NPI Last Update Date: | 07/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP17720 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |