Provider Demographics
NPI:1184866790
Name:MACHUCA, LILIAN NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LILIAN
Middle Name:NICOLE
Last Name:MACHUCA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13208 CARDINAL FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2169
Mailing Address - Country:US
Mailing Address - Phone:512-619-2069
Mailing Address - Fax:
Practice Address - Street 1:102 WESTLAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5373
Practice Address - Country:US
Practice Address - Phone:512-327-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7073000552163W00000X
TX768672163W00000X
TX1091847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse