Provider Demographics
NPI:1043645062
Name:DEAN, LILLIE MAE (REGNURSEPRACTIONER)
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:MAE
Last Name:DEAN
Suffix:
Gender:F
Credentials:REGNURSEPRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 RENNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219
Mailing Address - Country:US
Mailing Address - Phone:913-577-1641
Mailing Address - Fax:913-859-6887
Practice Address - Street 1:10101 RENNER BLVD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-9752
Practice Address - Country:US
Practice Address - Phone:913-577-1641
Practice Address - Fax:913-859-6887
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288380363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP19852Medicare UPIN