Provider Demographics
NPI:1407255540
Name:LILLIE, ANNA K (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:LILLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:K
Other - Last Name:HAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:25 N WINFIELD RD STE 519
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-938-6161
Mailing Address - Fax:630-938-6186
Practice Address - Street 1:25 N WINFIELD RD STE 519
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-938-6161
Practice Address - Fax:630-938-6186
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant