Provider Demographics
NPI:1326568528
Name:LILLIE, SARICA (CNP)
Entity Type:Individual
Prefix:
First Name:SARICA
Middle Name:
Last Name:LILLIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8034
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:90 CIC BLVD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8024
Practice Address - Country:US
Practice Address - Phone:937-544-8989
Practice Address - Fax:937-544-5659
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311443010OtherSOUTHERN OHIO SURGICAL ASSOCIATES, INC.