Provider Demographics
NPI:1063667335
Name:LILLICH, LAURA ELAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELAINE
Last Name:LILLICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ELAINE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-5202
Mailing Address - Country:US
Mailing Address - Phone:913-727-2516
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KANSAS HOSPITAL
Practice Address - Street 2:3901 RAINBOW BLVD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18647163W00000X
NC137352163W00000X
MO135074163W00000X
KS14-86886-092163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163W00000XNursing Service ProvidersRegistered Nurse