Provider Demographics
NPI:1417340464
Name:PRENTER, LILY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:PRENTER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 PENNSYLVANIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2664
Mailing Address - Country:US
Mailing Address - Phone:415-624-5067
Mailing Address - Fax:
Practice Address - Street 1:426 PENNSYLVANIA AVE APT A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2664
Practice Address - Country:US
Practice Address - Phone:415-624-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife