Provider Demographics
NPI:1508545948
Name:FARLEY-UKUTE, LILLIAR C (NURSES AIDE)
Entity Type:Individual
Prefix:
First Name:LILLIAR
Middle Name:C
Last Name:FARLEY-UKUTE
Suffix:
Gender:F
Credentials:NURSES AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 HERMITAGE WAY APT 315
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3821
Mailing Address - Country:US
Mailing Address - Phone:317-486-3779
Mailing Address - Fax:
Practice Address - Street 1:2315 HERMITAGE WAY APT 315
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3821
Practice Address - Country:US
Practice Address - Phone:317-486-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0300798376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide