Provider Demographics
NPI:1497326276
Name:SANNI, LILIAN NNEOMA
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:NNEOMA
Last Name:SANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E NEES AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0969
Mailing Address - Country:US
Mailing Address - Phone:512-983-8937
Mailing Address - Fax:
Practice Address - Street 1:540 E NEES AVE APT 214
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0969
Practice Address - Country:US
Practice Address - Phone:512-983-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program