Provider Demographics
NPI:1164865218
Name:PERRY, LILY MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2728
Mailing Address - Country:US
Mailing Address - Phone:714-960-2636
Mailing Address - Fax:
Practice Address - Street 1:1111 PARK ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2728
Practice Address - Country:US
Practice Address - Phone:714-960-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247087163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool