Provider Demographics
NPI:1437337573
Name:LILL, PAMELA MARIE
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:LILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:SCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 HWY 59 S
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:MN
Mailing Address - Zip Code:56715
Mailing Address - Country:US
Mailing Address - Phone:218-698-4285
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0633024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse