Provider Demographics
NPI:1417732587
Name:ZILLICH, LLYN RIVERS (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:LLYN
Middle Name:RIVERS
Last Name:ZILLICH
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:LLYN
Other - Middle Name:RIVERS
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1607 N GLASGOW DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5821
Mailing Address - Country:US
Mailing Address - Phone:704-796-5480
Mailing Address - Fax:
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6051
Practice Address - Country:US
Practice Address - Phone:208-625-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID77418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily